Provider Demographics
NPI:1114457892
Name:KORSON, DAWN (D-NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KORSON
Suffix:
Gender:F
Credentials:D-NP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:LONGCOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD STE 1710
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-5859
Practice Address - Fax:317-948-9939
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3203046140146N00000X
IL041.372695163W00000X
MI4704251540163W00000X
IL209.015571363LG0600X
IN28235617A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology