Provider Demographics
NPI:1669985792
Name:BLACK, DAWN MICHELLE (APRN FNP-C ACHPN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MICHELLE
Last Name:BLACK
Suffix:
Gender:F
Credentials:APRN FNP-C ACHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 KRONNER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-3404
Mailing Address - Country:US
Mailing Address - Phone:810-300-0323
Mailing Address - Fax:
Practice Address - Street 1:2372 KRONNER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MI
Practice Address - Zip Code:48063-3404
Practice Address - Country:US
Practice Address - Phone:810-300-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily