Healthcare Provider Details

I. General information

NPI: 1487604914
Provider Name (Legal Business Name): KATHLEEN LESLIE DUNN MS, RN, CRRN-A, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SAN DIEGO HS (128) 3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

5907 CHARING ST
SAN DIEGO CA
92117-4122
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-3185
  • Fax: 858-552-4315
Mailing address:
  • Phone: 858-292-1366
  • Fax: 858-552-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN246074
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SR0400X
TaxonomyRehabilitation Clinical Nurse Specialist
License NumberRN246074
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN246074
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN246074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: