Provider Demographics
NPI:1174824858
Name:MCGLOTHIN, DAWN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MCGLOTHIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1117
Mailing Address - Country:US
Mailing Address - Phone:310-486-7895
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E STE 300W
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4402
Practice Address - Country:US
Practice Address - Phone:310-486-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18550363LF0000X
IN28138471A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28138471AOtherIN LICENSE