Healthcare Provider Details

I. General information

NPI: 1467204016
Provider Name (Legal Business Name): CHANTELLE RENEE DAWSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax:
Mailing address:
  • Phone: 800-999-5829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704316273
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704316273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: