Provider Demographics
NPI:1134361686
Name:DUNLAP, JANE CAMPBELL (APRN, CRNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CAMPBELL
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:APRN, CRNP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LYNN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1551 DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4139
Mailing Address - Country:US
Mailing Address - Phone:706-884-2641
Mailing Address - Fax:706-884-2353
Practice Address - Street 1:1551 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4139
Practice Address - Country:US
Practice Address - Phone:706-884-2641
Practice Address - Fax:706-884-2353
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201888363LF0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39643Medicare UPIN