Provider Demographics
NPI:1023692233
Name:MCGOWAN-HARTMAN, DAWN MARIE (PBT)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:MCGOWAN-HARTMAN
Suffix:
Gender:F
Credentials:PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48767-9760
Mailing Address - Country:US
Mailing Address - Phone:989-239-1616
Mailing Address - Fax:
Practice Address - Street 1:6431 BROWN ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48767-9760
Practice Address - Country:US
Practice Address - Phone:989-239-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI66980246RP1900X
IL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy