Provider Demographics
NPI:1942271531
Name:DAWLEY, LAURIE A (CFNP/ANP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:DAWLEY
Suffix:
Gender:F
Credentials:CFNP/ANP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:LAVALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8902 N MERIDIAN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:INDPLS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5318
Mailing Address - Country:US
Mailing Address - Phone:317-844-6444
Mailing Address - Fax:317-848-6605
Practice Address - Street 1:8902 N MERIDIAN ST STE 210
Practice Address - Street 2:
Practice Address - City:INDPLS
Practice Address - State:IN
Practice Address - Zip Code:46260-5318
Practice Address - Country:US
Practice Address - Phone:317-844-6444
Practice Address - Fax:317-848-6605
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486643-1207RR0500X
NY333525363LF0000X
IN71003443A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0250900254Medicaid
S95889Medicare UPIN
NYBB8352Medicare ID - Type Unspecified