Healthcare Provider Details

I. General information

NPI: 1518609122
Provider Name (Legal Business Name): MARILYN A DUNNING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 KRUSE WAY STE 125
LAKE OSWEGO OR
97035-3533
US

IV. Provider business mailing address

4550 KRUSE WAY STE 125
LAKE OSWEGO OR
97035-3533
US

V. Phone/Fax

Practice location:
  • Phone: 503-864-5190
  • Fax: 844-897-5321
Mailing address:
  • Phone: 503-864-5190
  • Fax: 844-897-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10014871
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: