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General NPI Number Information
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NPI Number | 1780751479
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Entity Type | Individual
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Provider Name | SUSAN M DUNGAN NP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 1811 E BERT KOUNS SUITE 100
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-222-3695
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Fax | 318-424-0717
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Provider Business Mailing Address
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Address Line | 1844 GLEN COVE DR
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City | BENTON
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State | LA
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Zip | 71006-8414
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Country | US
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Telephone | 318-965-4341
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN089268 AP04806
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License Number State | LA
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