Provider Demographics
NPI:1518181098
Name:ANTLE, DAWN RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RENEE
Last Name:ANTLE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6016
Mailing Address - Country:US
Mailing Address - Phone:812-288-2488
Mailing Address - Fax:812-288-6603
Practice Address - Street 1:1804 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6016
Practice Address - Country:US
Practice Address - Phone:812-288-2488
Practice Address - Fax:812-288-6603
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002370A363LF0000X
KY71002370A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK162790OtherMEDICARE PTAN
IN71002370AOtherLISENSURE NUMBER
KY3007389OtherLICENSE NUMBER