Healthcare Provider Details

I. General information

NPI: 1316800675
Provider Name (Legal Business Name): KATINA INEZ DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N 7TH AVE STE D
POCATELLO ID
83201-5796
US

IV. Provider business mailing address

3844 JASON AVE APT B
POCATELLO ID
83204-2005
US

V. Phone/Fax

Practice location:
  • Phone: 208-242-3044
  • Fax: 208-904-0494
Mailing address:
  • Phone: 208-242-3044
  • Fax: 208-904-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: