MEDICARE: DAWN LORI MALCOLM

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	163W00000X	Registered Nurse	457541	CA

General Provider Information

NPI Number	:	1821802455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LORI MALCOLM

Provider Business Mailing Address
First Line	:	5035 S 174TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1419
Country	:	US
Telephone Number	:	402-813-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5035 S 174TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1419
Country	:	US
Telephone Number	:	402-813-2940
Fax Number	:

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

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ DAWN LORI MALCOLM ” Practice Location

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