MEDICARE: BREANNA DAWN DOVE PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1649964628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA DAWN DOVE PA-C

Provider Business Mailing Address
First Line	:	14540 PRAIRIE LAKES BLVD N STE 110
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-5051
Country	:	US
Telephone Number	:	317-982-5222
Fax Number	:	317-982-5223

Provider Business Practice Location Address
First Line	:	14540 PRAIRIE LAKES BLVD N STE 110
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-5051
Country	:	US
Telephone Number	:	317-982-5222
Fax Number	:	317-982-5223

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	03/17/2026

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Directions to “ BREANNA DAWN DOVE PA-C” Practice Location

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