Provider Demographics
NPI:1598794935
Name:DAWSON, NANCY LAVON (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LAVON
Last Name:DAWSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 E PIEDMONT RD APT 2235
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-8619
Mailing Address - Country:US
Mailing Address - Phone:480-766-1142
Mailing Address - Fax:
Practice Address - Street 1:5102 E PIEDMONT RD APT 2235
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-8619
Practice Address - Country:US
Practice Address - Phone:480-766-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2366363LF0000X
IN71002847A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily