Provider Demographics
NPI:1497041115
Name:LONG, DAWN NICHOLE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:NICHOLE
Last Name:LONG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5761 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5506
Mailing Address - Country:US
Mailing Address - Phone:702-341-6610
Mailing Address - Fax:
Practice Address - Street 1:5761 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5506
Practice Address - Country:US
Practice Address - Phone:702-341-6610
Practice Address - Fax:702-341-6961
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM622367A00000X
NV828524367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife