Healthcare Provider Details

I. General information

NPI: 1942278494
Provider Name (Legal Business Name): DIXIE K. DUNN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E AZTEC AVE
GALLUP NM
87301-5509
US

IV. Provider business mailing address

3194 BLUE HILL AVE
GALLUP NM
87301-6938
US

V. Phone/Fax

Practice location:
  • Phone: 505-721-1833
  • Fax:
Mailing address:
  • Phone: 505-721-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2030
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: