Provider Demographics
NPI:1417506320
Name:DOTY, DAWN L
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:L
Last Name:DOTY
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 1:80 N 2000 E RD.
Mailing Address - Street 2:
Mailing Address - City:BEECHER CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62414
Mailing Address - Country:US
Mailing Address - Phone:618-487-9164
Mailing Address - Fax:
Practice Address - Street 1:203 SOUTH SWEAZY
Practice Address - Street 2:
Practice Address - City:BEECHER CITY
Practice Address - State:IL
Practice Address - Zip Code:62414
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider