Provider Demographics
NPI:1568643146
Name:DAWSON, LYN ANN (CNP)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:ANN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 PINEHURST RD SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2219
Mailing Address - Country:US
Mailing Address - Phone:505-896-9412
Mailing Address - Fax:505-896-2505
Practice Address - Street 1:914 PINEHURST RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2219
Practice Address - Country:US
Practice Address - Phone:505-896-9412
Practice Address - Fax:505-896-2505
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41741363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCS00213187OtherCONTROLLED SUBSTANCE LIC