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NPI Code Detail

MEDICARE: ELIZABETH DUNLAP

MEDICARE: ELIZABETH DUNLAP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1093439184
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DUNLAP
Provider Business Mailing Address
First Line : 5601 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-459-6040
Fax Number : 260-459-6010
Provider Business Practice Location Address
First Line : 601 NOBLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5544
Country : US
Telephone Number : 260-420-9332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 12/09/2024

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Directions to “ ELIZABETH DUNLAP ” Practice Location

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