Provider Demographics
NPI:1013164425
Name:BURGESS, DAWN M (RNFA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1627
Mailing Address - Country:US
Mailing Address - Phone:812-476-4400
Mailing Address - Fax:812-476-0300
Practice Address - Street 1:2701 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1627
Practice Address - Country:US
Practice Address - Phone:812-476-4400
Practice Address - Fax:812-476-0300
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28159755A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4116028OtherAETNA
KY188985OtherHEALTHLINK PPO
IN221001OtherWELBORN HEALTHCARE
IL91107974OtherILLINOIS BLUE CROSS BLUE SHIELD
KY000000085654OtherKENTUCKY BLUE CROSS BLUE SHIELD
IN000000085654OtherINDIANA BLUE CROSS BLUE SHIELD