Provider Demographics
NPI:1508392325
Name:VANOVER, DAWN (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VANOVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 UNIVERSITY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4431
Mailing Address - Country:US
Mailing Address - Phone:806-712-1096
Mailing Address - Fax:
Practice Address - Street 1:775 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2211
Practice Address - Country:US
Practice Address - Phone:706-425-1550
Practice Address - Fax:706-425-1571
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner