Provider Demographics
NPI:1649879065
Name:NELL, DAWN KRISTINA (RPH)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:KRISTINA
Last Name:NELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3418
Mailing Address - Country:US
Mailing Address - Phone:992-098-8736
Mailing Address - Fax:
Practice Address - Street 1:1901 MARKET WAY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-7427
Practice Address - Country:US
Practice Address - Phone:920-261-8601
Practice Address - Fax:920-261-8615
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12010-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist