Provider Demographics
NPI:1851286793
Name:THEKKUMTHOTTAM, DAWN VALERIE (RN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:VALERIE
Last Name:THEKKUMTHOTTAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:VALERIE
Other - Last Name:DUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2246 E WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3911
Mailing Address - Country:US
Mailing Address - Phone:559-691-8443
Mailing Address - Fax:
Practice Address - Street 1:2615 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2223
Practice Address - Country:US
Practice Address - Phone:559-225-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse