Healthcare Provider Details

I. General information

NPI: 1720994635
Provider Name (Legal Business Name): SERENA DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

3601 FAIRFAX DR APT 206
ARLINGTON VA
22201-2387
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-9892
  • Fax:
Mailing address:
  • Phone: 805-259-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001347854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: