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General NPI Number Information
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NPI Number | 1225678543
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Entity Type | Individual
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Provider Name | CHARLA MARIE DUNN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 2100 N MLK BLVD
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City | CLOVIS
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State | NM
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Zip | 88101-9412
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Country | US
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Telephone | 575-769-7494
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Fax | 575-769-7324
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Provider Business Mailing Address
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Address Line | 2100 N MLK BLVD
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City | CLOVIS
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State | NM
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Zip | 88101-9412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2020-061
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License Number State | NM
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