Healthcare Provider Details

I. General information

NPI: 1255316840
Provider Name (Legal Business Name): JONATHAN RICHARD DUNN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 WOODMONT RIDGE CT
CLEMMONS NC
27012-9638
US

IV. Provider business mailing address

5030 WOODMONT RIDGE CT
CLEMMONS NC
27012-9638
US

V. Phone/Fax

Practice location:
  • Phone: 336-703-1233
  • Fax:
Mailing address:
  • Phone: 336-703-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141399
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: