Provider Demographics
NPI:1861766974
Name:DUNN, NINA GRACE
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:GRACE
Last Name:DUNN
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 1:706 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4277
Mailing Address - Country:US
Mailing Address - Phone:708-692-5418
Mailing Address - Fax:
Practice Address - Street 1:401 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4716
Practice Address - Country:US
Practice Address - Phone:217-398-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker