Healthcare Provider Details

I. General information

NPI: 1609928654
Provider Name (Legal Business Name): BRENDA B. DAWSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSON ST
TALLULAH LA
71282-5513
US

IV. Provider business mailing address

819 HIGHWAY 580
TRANSYLVANIA LA
71286-5811
US

V. Phone/Fax

Practice location:
  • Phone: 318-574-1713
  • Fax: 318-574-2299
Mailing address:
  • Phone: 318-552-7685
  • Fax: 318-552-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN038698
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: