Healthcare Provider Details

I. General information

NPI: 1275698581
Provider Name (Legal Business Name): KATHRYN ELLEN DUNN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD
FREDERICKSBURG VA
22401-4453
US

IV. Provider business mailing address

3100 SPRING FOREST RD
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1100
  • Fax: 919-873-9821
Mailing address:
  • Phone: 919-882-0705
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001203939
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: