MEDICARE: DAWN MARIE DUBEAU PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	50662	WY

General Provider Information

NPI Number	:	1225722879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MARIE DUBEAU PMHNP-BC

Provider Business Mailing Address
First Line	:	705 E WASHINGTON AVE
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4452
Country	:	US
Telephone Number	:	307-463-0541
Fax Number	:	307-463-0494

Provider Business Practice Location Address
First Line	:	705 E WASHINGTON AVE
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4452
Country	:	US
Telephone Number	:	307-463-0541
Fax Number	:	307-463-0494

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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