MEDICARE: DAWNELLE SHAW STEDING

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	363LW0102X	Women's Health Nurse Practitioner	RN187046	GA
2	363LA2200X	Adult Health Nurse Practitioner	RN187046	GA

General Provider Information

NPI Number	:	1760822779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWNELLE SHAW STEDING

Provider Business Mailing Address
First Line	:	5301 WESTCHESTER RDG NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-7802
Country	:	US
Telephone Number	:	407-925-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 WESTCHESTER RDG NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-7802
Country	:	US
Telephone Number	:	770-580-0518
Fax Number	:

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

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	04/08/2014

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