Provider Demographics
NPI:1770818528
Name:ROXBOROUGH, DAWN MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:ROXBOROUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 HALL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5735
Mailing Address - Country:US
Mailing Address - Phone:586-991-0700
Mailing Address - Fax:586-991-0701
Practice Address - Street 1:11051 HALL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5735
Practice Address - Country:US
Practice Address - Phone:586-991-0700
Practice Address - Fax:586-991-0701
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily