MEDICARE: DEREK LAWRENCE DUNNIGAN NP-C

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	RN 302547	OH
2	363LF0000X	Family Nurse Practitioner	COA 10818-NP	OH

General Provider Information

NPI Number	:	1528299104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK LAWRENCE DUNNIGAN NP-C

Provider Business Mailing Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

Provider Business Practice Location Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

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

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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