Provider Demographics
NPI:1508311150
Name:ROELOFS, DAWN MARIE (NP-C, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:ROELOFS
Suffix:
Gender:F
Credentials:NP-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7962 COVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4875
Mailing Address - Country:US
Mailing Address - Phone:410-245-1806
Mailing Address - Fax:
Practice Address - Street 1:7962 COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4875
Practice Address - Country:US
Practice Address - Phone:410-245-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143946163W00000X, 363LF0000X
PARN669051163W00000X
DCRN1038448163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse