MEDICARE: ANNY LOU MANDAPAT DUNHAM APRN-CNP

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
1	363LF0000X	Family Nurse Practitioner	101037	OK

General Provider Information

NPI Number	:	1194368316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNY LOU MANDAPAT DUNHAM APRN-CNP

Provider Business Mailing Address
First Line	:	13310 N EASTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1816
Country	:	US
Telephone Number	:	405-513-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 SW 104TH STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139
Country	:	US
Telephone Number	:	405-691-3100
Fax Number	:	405-691-3106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	12/05/2022

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