Provider Demographics
NPI:1144813478
Name:DUNLAP, NITA J
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:J
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3433
Mailing Address - Country:US
Mailing Address - Phone:304-545-8586
Mailing Address - Fax:
Practice Address - Street 1:325 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-3433
Practice Address - Country:US
Practice Address - Phone:304-545-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker