Provider Demographics
NPI:1467760264
Name:WILLARD, DAWN M (APN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:WILLARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7158 PAINTED PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7158 PAINTED PARADISE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2851
Practice Address - Country:US
Practice Address - Phone:702-737-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN 001226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEA253ZMedicare PIN
V110571Medicare PIN