Provider Demographics
NPI:1891956512
Name:DAWSON, MONICA ELAINE (MED, MLT, CT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ELAINE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MED, MLT, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 37TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1812
Mailing Address - Country:US
Mailing Address - Phone:505-994-0350
Mailing Address - Fax:505-994-0350
Practice Address - Street 1:1504 37TH ST SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1812
Practice Address - Country:US
Practice Address - Phone:505-994-0350
Practice Address - Fax:505-994-0350
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2040310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility