Healthcare Provider Details

I. General information

NPI: 1053597518
Provider Name (Legal Business Name): ERSHELA DAWN DEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DRIVE
LEXINGTON KY
40502-9987
US

IV. Provider business mailing address

2525 ASHBROOKE DR
LEXINGTON KY
40513-1432
US

V. Phone/Fax

Practice location:
  • Phone: 859-281-3939
  • Fax:
Mailing address:
  • Phone: 859-229-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1092096
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: