Provider Demographics
NPI:1710061551
Name:WALSTON, DAWN M (MSN AHCNS, APRN-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:WALSTON
Suffix:
Gender:F
Credentials:MSN AHCNS, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5761
Mailing Address - Country:US
Mailing Address - Phone:573-331-6710
Mailing Address - Fax:573-986-5999
Practice Address - Street 1:371 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5761
Practice Address - Country:US
Practice Address - Phone:573-331-6710
Practice Address - Fax:573-986-5999
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO090149OtherMO LICENSE NUMBER
MO20040028-05OtherMO CERTIFICATION NUMBER