Provider Demographics
NPI:1316193196
Name:ROSE, DAWN M (RN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1519 NYE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9133
Mailing Address - Country:US
Mailing Address - Phone:315-946-5749
Mailing Address - Fax:315-946-7114
Practice Address - Street 1:1519 NYE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9133
Practice Address - Country:US
Practice Address - Phone:315-946-5749
Practice Address - Fax:315-946-7114
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY292510-1163WC0400X, 163WC1500X, 163WH0200X, 163WI0600X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn