Provider Demographics
NPI:1518056548
Name:LEDAHL, DAWN M (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:LEDAHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:BARBOT-LEDAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:14737 HIGHWAY 2 WEST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-9014
Mailing Address - Country:US
Mailing Address - Phone:701-875-3268
Mailing Address - Fax:
Practice Address - Street 1:1102 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4233
Practice Address - Country:US
Practice Address - Phone:701-572-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4699183500000X
MT3833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist