Provider Demographics
NPI:1689989360
Name:FAVORS-HULL, DAWN LACHELL (LPN)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:LACHELL
Last Name:FAVORS-HULL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9366 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7870
Mailing Address - Country:US
Mailing Address - Phone:937-520-8255
Mailing Address - Fax:
Practice Address - Street 1:9366 EASTBROOK DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7870
Practice Address - Country:US
Practice Address - Phone:937-520-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-131637M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse