Provider Demographics
NPI:1114247913
Name:CLIFTON, DAWN MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:CRNP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57950 LEAVENWORTH AVE BLDG 250
Mailing Address - Street 2:22D MEDICAL GROUP
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221
Mailing Address - Country:US
Mailing Address - Phone:316-759-1622
Mailing Address - Fax:316-759-6030
Practice Address - Street 1:57950 LEAVENWORTH AVE BLDG 250
Practice Address - Street 2:22D MEDICAL GROUP
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221
Practice Address - Country:US
Practice Address - Phone:316-759-1622
Practice Address - Fax:316-759-6030
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-119377363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health