Provider Demographics
NPI:1366437907
Name:DUNBAR, CHRISTY CLEMENZ (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:CLEMENZ
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E COLUMBIA AVE
Mailing Address - Street 2:PO BOX 3608
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7318
Mailing Address - Country:US
Mailing Address - Phone:803-532-8155
Mailing Address - Fax:803-532-9685
Practice Address - Street 1:608 EAST COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070
Practice Address - Country:US
Practice Address - Phone:803-532-8155
Practice Address - Fax:803-532-9685
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 686363LF0000X
SC686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ31656Medicare UPIN
SCQ316Medicare UPIN