Provider Demographics
NPI:1457824161
Name:DAWN MEDI SPA, INC
Entity Type:Organization
Organization Name:DAWN MEDI SPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:KOCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-CNP
Authorized Official - Phone:918-728-8383
Mailing Address - Street 1:1243 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-4915
Mailing Address - Country:US
Mailing Address - Phone:918-728-8383
Mailing Address - Fax:918-512-7679
Practice Address - Street 1:1243 SOUTH HARVARD AVE
Practice Address - Street 2:DAWN MEDI SPA, INC
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112
Practice Address - Country:US
Practice Address - Phone:918-728-8383
Practice Address - Fax:918-512-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty