Provider Demographics
NPI:1134542186
Name:SCHALLOCK, DAWN LOREE (MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LOREE
Last Name:SCHALLOCK
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 PEACHTREE HILLS RD.
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012
Mailing Address - Country:US
Mailing Address - Phone:575-527-9490
Mailing Address - Fax:575-527-9491
Practice Address - Street 1:4675 PEACHTREE HILLS RD.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012
Practice Address - Country:US
Practice Address - Phone:575-527-9490
Practice Address - Fax:575-527-9491
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR23259163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool