Healthcare Provider Details

I. General information

NPI: 1376143560
Provider Name (Legal Business Name): DAWN DEE OSTBERG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 HARMON LOOP RD STE 108
DEDEDO GU
96929-6544
US

IV. Provider business mailing address

240R ENRIQUE SAN NICOLAS
TALOFOFO GU
96915-3630
US

V. Phone/Fax

Practice location:
  • Phone: 671-633-4404
  • Fax: 671-633-4452
Mailing address:
  • Phone: 671-788-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20NP03
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP0222
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: