MEDICARE: MICHELLE DAWN

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	163WM0705X	Medical-Surgical Registered Nurse	1620030	CO
2	163WM0705X	Medical-Surgical Registered Nurse	36727	AK

General Provider Information

NPI Number	:	1548665110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DAWN

Provider Business Mailing Address
First Line	:	5977 DUNRAVEN ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-1007
Country	:	US
Telephone Number	:	720-323-7954
Fax Number	:

Provider Business Practice Location Address
First Line	:	5977 DUNRAVEN ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-1007
Country	:	US
Telephone Number	:	720-323-7954
Fax Number	:

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

Provider Enumeration Date	:	10/25/2014
Last Update Date	:	10/25/2014

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Directions to “ MICHELLE DAWN ” Practice Location

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