Provider Demographics
NPI:1295523181
Name:DAWE, KELLY ANN (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:DAWE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MEAD FARM RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2453
Mailing Address - Country:US
Mailing Address - Phone:203-231-3622
Mailing Address - Fax:800-755-7601
Practice Address - Street 1:17 MEAD FARM RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2453
Practice Address - Country:US
Practice Address - Phone:203-231-3622
Practice Address - Fax:800-755-7601
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT139872163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy