Healthcare Provider Details

I. General information

NPI: 1144986951
Provider Name (Legal Business Name): CARMEN DUNBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROBBIE MINCE WAY
DESOTO TX
75115-2012
US

IV. Provider business mailing address

4012 SW GREEN OAKS BLVD
ARLINGTON TX
76017-4113
US

V. Phone/Fax

Practice location:
  • Phone: 972-709-7190
  • Fax:
Mailing address:
  • Phone: 817-572-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1024033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: