Provider Demographics
NPI:1477587129
Name:MAXIM, DAWN A (APRN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:A
Last Name:MAXIM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:ALLGEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50050109OtherPASSPORT - NIS
KY146607OtherSIHO-NIS
KY000000814123OtherANTHEM - NIS
KY78012457Medicaid
IN200923230Medicaid
IN200923230Medicaid
KYK030980Medicare Oscar/Certification
KY50050109OtherPASSPORT - NIS
KYP00957738Medicare PIN
KYK030981Medicare PIN