Provider Demographics
NPI:1780208983
Name:LAROCK, DAWN M (LPN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:LAROCK
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 1:29 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1140
Mailing Address - Country:US
Mailing Address - Phone:315-329-1646
Mailing Address - Fax:
Practice Address - Street 1:113 SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1652
Practice Address - Country:US
Practice Address - Phone:315-887-5156
Practice Address - Fax:315-887-5163
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319149-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse