Provider Demographics
NPI:1023704434
Name:MCCLURE, DAWN M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:8470 CARSON PL UNIT 30
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3590
Mailing Address - Country:US
Mailing Address - Phone:314-440-8502
Mailing Address - Fax:
Practice Address - Street 1:8470 CARSON PL UNIT 30
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3590
Practice Address - Country:US
Practice Address - Phone:314-440-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95022983363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care