MEDICARE: MARY ANN DUNLAP ANP

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	363LA2200X	Adult Health Nurse Practitioner	0094000300N3	OR
2	163W00000X	Registered Nurse	94000300N3	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629002639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN DUNLAP ANP

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:	503-215-6644

Provider Business Practice Location Address
First Line	:	12442 SW SCHOLLS FERRY RD
Second Line	:	SUITE 100
City	:	TIGARD
State	:	OR
Zip	:	97223-0803
Country	:	US
Telephone Number	:	503-215-9900
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/01/2024

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