Healthcare Provider Details

I. General information

NPI: 1114851920
Provider Name (Legal Business Name): ADRIENNE DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HUMMINGBIRD LN
INDEPENDENCE WV
26374-8516
US

IV. Provider business mailing address

122 HUMMINGBIRD LN
INDEPENDENCE WV
26374-8516
US

V. Phone/Fax

Practice location:
  • Phone: 724-557-0407
  • Fax:
Mailing address:
  • Phone: 724-557-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number33176
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: