Provider Demographics
NPI:1730500596
Name:ONYEWURUNWA, DAWN (CLC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ONYEWURUNWA
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11553 RICKMAN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2421
Mailing Address - Country:US
Mailing Address - Phone:313-720-2863
Mailing Address - Fax:
Practice Address - Street 1:11553 RICKMAN DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2421
Practice Address - Country:US
Practice Address - Phone:313-720-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIALPP-201569174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN