Healthcare Provider Details

I. General information

NPI: 1114095585
Provider Name (Legal Business Name): ROSIE DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PARK CITY CT APT 3102
SACRAMENTO CA
95831-3899
US

IV. Provider business mailing address

40 PARK CITY CT APT 3102
SACRAMENTO CA
95831-3899
US

V. Phone/Fax

Practice location:
  • Phone: 209-915-9162
  • Fax:
Mailing address:
  • Phone: 209-915-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: