Healthcare Provider Details

I. General information

NPI: 1093294878
Provider Name (Legal Business Name): DAWN NICOLE NICHOLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DAWN NICOLE THOMASON

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

26937 N 89TH DR
PEORIA AZ
85383-3725
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-6100
  • Fax:
Mailing address:
  • Phone: 520-400-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN128431
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number218008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: