Provider Demographics
NPI:1326429069
Name:DEGROAT, DAWN MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:DEGROAT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42298 MEW CONNECTICUT RD
Mailing Address - Street 2:
Mailing Address - City:THERESA
Mailing Address - State:NY
Mailing Address - Zip Code:13691
Mailing Address - Country:US
Mailing Address - Phone:315-755-8353
Mailing Address - Fax:
Practice Address - Street 1:42298 MEW CONNECTICUT RD
Practice Address - Street 2:
Practice Address - City:THERESA
Practice Address - State:NY
Practice Address - Zip Code:13691
Practice Address - Country:US
Practice Address - Phone:315-755-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10309686164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse