Healthcare Provider Details

I. General information

NPI: 1063042257
Provider Name (Legal Business Name): DAWN CRIST LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 LOW LN
TODDVILLE IA
52341-9629
US

IV. Provider business mailing address

3515 LOW LN
TODDVILLE IA
52341-9629
US

V. Phone/Fax

Practice location:
  • Phone: 319-330-2539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM0006
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number308-49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: