Provider Demographics
NPI:1780186833
Name:CORDONE, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:CORDONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9689 SAINT CLAIR HWY
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:MI
Mailing Address - Zip Code:48064-1109
Mailing Address - Country:US
Mailing Address - Phone:586-430-4075
Mailing Address - Fax:
Practice Address - Street 1:37282 31 MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1931
Practice Address - Country:US
Practice Address - Phone:810-328-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175112363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care