Provider Demographics
NPI:1063813889
Name:GOLDSTEIN, DAWN M (PMHNPBC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PMHNPBC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-355-8270
Mailing Address - Fax:517-353-5582
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7500
Practice Address - Country:US
Practice Address - Phone:517-355-8270
Practice Address - Fax:517-353-5582
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704161955363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health