Provider Demographics
NPI:1184947038
Name:STEWART, DAWN MANGUM (MSN RN FNP-BC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MANGUM
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSN RN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8097 FREUDENBERG DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-5621
Mailing Address - Country:US
Mailing Address - Phone:901-829-2304
Mailing Address - Fax:
Practice Address - Street 1:76 TABB DR
Practice Address - Street 2:SUITE E
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058
Practice Address - Country:US
Practice Address - Phone:901-840-2102
Practice Address - Fax:901-840-1979
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily