Healthcare Provider Details

I. General information

NPI: 1801120050
Provider Name (Legal Business Name): CATHRYN DUNTY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5350
US

IV. Provider business mailing address

1814 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5350
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-3666
  • Fax: 910-937-0930
Mailing address:
  • Phone: 910-452-3666
  • Fax: 910-937-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-01330
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number001003316
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: