Healthcare Provider Details

I. General information

NPI: 1871321737
Provider Name (Legal Business Name): BREANNA CELESTE DAWSON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON ST
LOUISVILLE KY
40202-1675
US

IV. Provider business mailing address

1700 MARINAS EDGE WAY APT 710
LOUISVILLE KY
40206-1590
US

V. Phone/Fax

Practice location:
  • Phone: 502-526-3570
  • Fax:
Mailing address:
  • Phone: 502-471-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1179755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: