Healthcare Provider Details

I. General information

NPI: 1558973024
Provider Name (Legal Business Name): DAWN ST. LUCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 FEDERAL ST
GREENFIELD MA
01301-1932
US

IV. Provider business mailing address

672 WESTERN AVE
BRATTLEBORO VT
05301-6284
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-0249
  • Fax:
Mailing address:
  • Phone: 802-490-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2302710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: