Provider Demographics
NPI:1346841095
Name:CASON, DWAYNE
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:
Last Name:CASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6149
Mailing Address - Country:US
Mailing Address - Phone:701-712-1096
Mailing Address - Fax:701-483-3425
Practice Address - Street 1:1028 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6149
Practice Address - Country:US
Practice Address - Phone:701-712-1096
Practice Address - Fax:701-483-3425
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant