Provider Demographics
NPI:1811358419
Name:ELLER, DAWN (ND)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N AURORA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4201
Mailing Address - Country:US
Mailing Address - Phone:607-351-0332
Mailing Address - Fax:160-726-1117
Practice Address - Street 1:317 N AURORA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4201
Practice Address - Country:US
Practice Address - Phone:607-351-0332
Practice Address - Fax:160-726-1117
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0000209175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath