Provider Demographics
NPI:1255651485
Name:DAWSON, CHANTEL C M (LPN)
Entity type:Individual
Prefix:MS
First Name:CHANTEL
Middle Name:C M
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 N SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2426
Mailing Address - Country:US
Mailing Address - Phone:414-213-8257
Mailing Address - Fax:
Practice Address - Street 1:2773 N SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2426
Practice Address - Country:US
Practice Address - Phone:414-213-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306913-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse