MEDICARE: PEG DUNN CNM NURSE-MIDWIFERY SERVICE

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	367A00000X	Advanced Practice Midwife	4704170453	MI

General Provider Information

NPI Number	:	1952655904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEG DUNN CNM NURSE-MIDWIFERY SERVICE

Provider Business Mailing Address
First Line	:	515 W 14TH ST
Second Line	:	SUITE D
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4059
Country	:	US
Telephone Number	:	231-941-5568
Fax Number	:	231-941-5578

Provider Business Practice Location Address
First Line	:	515 W 14TH ST
Second Line	:	SUITE D
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4059
Country	:	US
Telephone Number	:	231-941-5568
Fax Number	:	231-941-5578

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MARY MARGARET DUNN
Credential	:	CNM
Telephone Number	:	231-941-5568

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/10/2014

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