Provider Demographics
NPI:1659604361
Name:UTZMAN, DAWN P (CNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:P
Last Name:UTZMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 FLORMANN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-718-3300
Practice Address - Fax:605-718-3436
Is Sole Proprietor?:No
Enumeration Date:2009-09-13
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR026871363L00000X
SDCP000577363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR026871OtherLICENSE
S103722Medicare PIN