Provider Demographics
NPI:1194182980
Name:MARTIN, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 N LINDBERGH BLVD
Mailing Address - Street 2:SUITE #170
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2019
Mailing Address - Country:US
Mailing Address - Phone:314-656-1430
Mailing Address - Fax:314-754-9419
Practice Address - Street 1:7220 N LINDBERGH BLVD
Practice Address - Street 2:SUITE #170
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2019
Practice Address - Country:US
Practice Address - Phone:314-656-1430
Practice Address - Fax:314-754-9419
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion