Sue Ellen Dunham, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704082241 Issued in MI

Practice address

4020 Copper VW Ste 104
Traverse City, MI 49684

Phone

(231) 421-6921

Fax

(231) 421-7852

NPI assigned

Aug 9, 2006

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Countryside Health Clnic LLC

  • Nurse Practitioner
  • Marion, MI
  • NPI 1447262373
  NPD (past)
• Integrated Physician Solutions PC

  • Home Health Agency
  • Southfield, MI
  • NPI 1992110662
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1427068790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3785 BAY RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032433",
            "telephone_number": "989-791-2455",
            "fax_number": "989-791-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 COPPER VW STE 104",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-421-6921",
            "fax_number": "231-421-7852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 E 7th St",
            "address_purpose": "LOCATION",
            "city": "Manton",
            "state": "MI",
            "postal_code": "496639429",
            "country_code": "US",
            "telephone_number": "231-824-4100",
            "fax_number": "231-824-4108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 E 7th St",
            "address_purpose": "LOCATION",
            "city": "Manton",
            "state": "MI",
            "postal_code": "496639429",
            "country_code": "US",
            "telephone_number": "231-824-4100",
            "fax_number": "231-824-4108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUNHAM",
        "first_name": "SUE",
        "middle_name": "ELLEN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704082241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5008770670",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945609-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jay Edgar Dujon, M.D.
• Jennifer Duman, MMT
• Crystal Duncan, LMSW
• Ryann Duncan
• Ashley Dunham-Smith, LMSW
• Andrea Dunklow
• Judy Dunmire, RPH
• Emma Jonelle Dunn, MD
• Sallie Dunn, RPH
• Ian Hamilton Dunscombe, OD

• Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.