Provider Demographics
NPI:1891728077
Name:DANIELS, DAWN PETINA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:PETINA
Last Name:DANIELS
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 1:3804 ROAD 147
Mailing Address - Street 2:P.O. BOX 43
Mailing Address - City:LODGEPOLE
Mailing Address - State:NE
Mailing Address - Zip Code:69149-5054
Mailing Address - Country:US
Mailing Address - Phone:308-483-5489
Mailing Address - Fax:
Practice Address - Street 1:638 N 109TH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1722
Practice Address - Country:US
Practice Address - Phone:402-345-2200
Practice Address - Fax:402-345-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19356164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse