Healthcare Provider Details
I. General information
NPI: 1285625673
Provider Name (Legal Business Name): JANICE DORIS SUNDNAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/03/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
543 NORTH ST
NEW BEDFORD MA
02740-2782
US
IV. Provider business mailing address
200 MILL RD STE 180
FAIRHAVEN MA
02719-5255
US
V. Phone/Fax
- Phone: 508-973-2208
- Fax: 508-973-1225
- Phone: 508-973-2000
- Fax: 508-973-2001
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LX0001X |
| Taxonomy | Obstetrics & Gynecology Nurse Practitioner |
| License Number | RN244451 |
| License Number State | MA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: