Provider Demographics
NPI:1841512191
Name:NIEMANN, DAWN (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:NIEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:78 EAST 900 NORTH
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660
Mailing Address - Country:US
Mailing Address - Phone:801-794-1054
Mailing Address - Fax:801-794-1055
Practice Address - Street 1:78 E 900 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1232
Practice Address - Country:US
Practice Address - Phone:801-794-1054
Practice Address - Fax:801-794-1055
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1908818900363LF0000X
UT190881 8900363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS62500Medicare UPIN