Healthcare Provider Details

I. General information

NPI: 1952792848
Provider Name (Legal Business Name): MS. REBECCA DUNNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S CLINTON ST
STOCKBRIDGE MI
49285-9570
US

IV. Provider business mailing address

616 S CLINTON ST
STOCKBRIDGE MI
49285-9570
US

V. Phone/Fax

Practice location:
  • Phone: 517-416-8663
  • Fax:
Mailing address:
  • Phone: 517-416-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberAS330318291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: