Healthcare Provider Details

I. General information

NPI: 1568452134
Provider Name (Legal Business Name): LYNN DUNSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HERITAGE CIR
PAWNEE OK
74058-3744
US

IV. Provider business mailing address

101 PARK PL
PONCA CITY OK
74604-5688
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-6546
  • Fax: 918-762-4614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberROO52158
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: