Healthcare Provider Details

I. General information

NPI: 1821147539
Provider Name (Legal Business Name): DAWN LEE ACKERMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 N WATER ST
DECATUR IL
62526-2472
US

IV. Provider business mailing address

400 KIRK DR
MT ZION IL
62549-1612
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5320
  • Fax:
Mailing address:
  • Phone: 269-655-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003061
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: