Provider Demographics
NPI:1326135351
Name:WALLERSTEDT, DAWN BELLANTI (NP)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:BELLANTI
Last Name:WALLERSTEDT
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Gender:F
Credentials:NP
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Mailing Address - Street 1:11100 LUND PL
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1623
Mailing Address - Country:US
Mailing Address - Phone:301-435-5777
Mailing Address - Fax:301-480-3159
Practice Address - Street 1:NIH/ NCCAM
Practice Address - Street 2:10 CENTER DRIVE 4NW 1730 MSC 1302
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-435-5777
Practice Address - Fax:301-480-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDR082034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily