Provider Demographics
NPI:1457637100
Name:DAWSON, DIANA (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 PINEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1850
Mailing Address - Country:US
Mailing Address - Phone:402-770-7855
Mailing Address - Fax:
Practice Address - Street 1:8300 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3705
Practice Address - Country:US
Practice Address - Phone:402-464-8302
Practice Address - Fax:402-464-8308
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist