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NPI Code Detail

MEDICARE: ERIC LEE DUNSMOOR NP

MEDICARE: ERIC LEE DUNSMOOR NP
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
1363LF0000XFamily Nurse Practitioner142395WI
2363LF0000XFamily Nurse PractitionerR153869-4MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992799506
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC LEE DUNSMOOR NP
Provider Business Mailing Address
First Line : 1500 CURVE CREST BLVD W
Second Line :
City : STILLWATER
State : MN
Zip : 55082-6040
Country : US
Telephone Number : 651-439-1234
Fax Number : 651-275-3325
Provider Business Practice Location Address
First Line : 1500 CURVE CREST BLVD W
Second Line :
City : STILLWATER
State : MN
Zip : 55082-6040
Country : US
Telephone Number : 651-439-1234
Fax Number : 651-439-1547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 02/15/2011

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