MEDICARE: DAWN LEANNE VIETS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	81603	NM
2	363LN0000X	Neonatal Nurse Practitioner	NNP 118354	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053359091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LEANNE VIETS NP

Provider Business Mailing Address
First Line	:	312 COPPER OAKS DR
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-8444
Country	:	US
Telephone Number	:	816-260-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 COPPER OAKS DR
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-8444
Country	:	US
Telephone Number	:	816-260-5857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	11/18/2024

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