Healthcare Provider Details

I. General information

NPI: 1366412009
Provider Name (Legal Business Name): KRISTEN DUNN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST
WOLFEBORO NH
03894-4411
US

IV. Provider business mailing address

984 WHITTIER HIGHWAY
MOULTONBOROUGH NH
03254
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7500
  • Fax:
Mailing address:
  • Phone: 603-476-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: