Healthcare Provider Details

I. General information

NPI: 1255111738
Provider Name (Legal Business Name): TODD DUNKEL MS, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

34334 WHITE OAK LN
CUMMING IA
50061-4430
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-3173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number173369
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: