Provider Demographics
NPI:1013634617
Name:SMITH, DAWN DOMINIQUE BROOKS (DNPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:DOMINIQUE BROOKS
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19273 LEWALLEN CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8666
Mailing Address - Country:US
Mailing Address - Phone:530-223-5107
Mailing Address - Fax:
Practice Address - Street 1:19273 LEWALLEN CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-8666
Practice Address - Country:US
Practice Address - Phone:530-941-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547641163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice