Provider Demographics
NPI:1801639950
Name:FENDER, DAWN
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:FENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15847 W SOUTH RANGE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9130
Mailing Address - Country:US
Mailing Address - Phone:330-519-1901
Mailing Address - Fax:
Practice Address - Street 1:15847 W SOUTH RANGE RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9130
Practice Address - Country:US
Practice Address - Phone:330-519-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide