Provider Demographics
NPI:1831220169
Name:ST. CLAIR, DAWN MARIE (LPN)
Entity type:Individual
Prefix:MR
First Name:DAWN
Middle Name:MARIE
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7918 PRAIRIE WOODS ST.
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636
Mailing Address - Country:US
Mailing Address - Phone:608-790-3525
Mailing Address - Fax:
Practice Address - Street 1:118 N CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:BUFFALO CITY
Practice Address - State:WI
Practice Address - Zip Code:54622
Practice Address - Country:US
Practice Address - Phone:608-248-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23824-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse