Provider Demographics
NPI:1255078952
Name:ELDRED, DAWN MICHELE (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:ELDRED
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1554
Mailing Address - Country:US
Mailing Address - Phone:814-373-9420
Mailing Address - Fax:
Practice Address - Street 1:1885 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1278
Practice Address - Country:US
Practice Address - Phone:814-456-5433
Practice Address - Fax:814-723-2483
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025662363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health