Provider Demographics
NPI:1508658162
Name:HATCHEW, DAWN RAY (AGCNS-BC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RAY
Last Name:HATCHEW
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 INDIAN LAKES RD NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-8541
Mailing Address - Country:US
Mailing Address - Phone:616-799-4645
Mailing Address - Fax:
Practice Address - Street 1:333 INDIAN LAKES RD NE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-8541
Practice Address - Country:US
Practice Address - Phone:616-799-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2024103706364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist