Provider Demographics
NPI:1740657923
Name:LOPEZ, DAWSON KRAIN (WHNP-BC, A-GPCNP-C)
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:KRAIN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:WHNP-BC, A-GPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-3777
Mailing Address - Fax:520-682-2333
Practice Address - Street 1:12635 W RUDASILL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9724
Practice Address - Country:US
Practice Address - Phone:520-682-3777
Practice Address - Fax:520-682-2333
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8005363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079834Medicaid