Healthcare Provider Details

I. General information

NPI: 1083971527
Provider Name (Legal Business Name): FAMATTA JUSU DUNOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E MAIN ST STE 205
WHITEHALL OH
43213-2574
US

IV. Provider business mailing address

5340 E MAIN ST STE 205
WHITEHALL OH
43213-2574
US

V. Phone/Fax

Practice location:
  • Phone: 614-446-2947
  • Fax:
Mailing address:
  • Phone: 614-446-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024041972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: