Individual
SUE ELLEN DUNHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4020 COPPER VW STE 104, TRAVERSE CITY, MI 49684
(231) 421-6921
(231) 421-7852
Mailing address
3785 BAY RD, SAGINAW, MI 48603-2433
(989) 791-2455
(989) 791-1392
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704082241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4945609-10
—
MI
01
—
5008770670
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/09/2006
Last updated
04/17/2019
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