=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003209495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHANIE M. DUNBAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 12/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 FOREST OAK CT
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21015-6170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-688-7792
-----------------------------------------------------
Fax | 410-836-8064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10845 PHILADELPHIA RD
-----------------------------------------------------
City | WHITE MARSH
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21162-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-335-0008
-----------------------------------------------------
Fax | 410-335-3113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHANIE MILLER DUNBAR
-----------------------------------------------------
Credential | MSN, CRNA
-----------------------------------------------------
Telephone | 410-688-7792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------