Provider Demographics
NPI:1386690493
Name:WIEZOREK, DAWN MARIE
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:WIEZOREK
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 1:1201 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2424
Mailing Address - Country:US
Mailing Address - Phone:218-529-3109
Mailing Address - Fax:
Practice Address - Street 1:1201 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2424
Practice Address - Country:US
Practice Address - Phone:218-529-3109
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other