Healthcare Provider Details

I. General information

NPI: 1063813889
Provider Name (Legal Business Name): DAWN M GOLDSTEIN PMHNPBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN M HARRISON RN

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MICHIGAN AVE STE 320N
YPSILANTI MI
48197-5443
US

IV. Provider business mailing address

501 N RIVER ST
YPSILANTI MI
48198-2818
US

V. Phone/Fax

Practice location:
  • Phone: 734-879-1378
  • Fax: 734-879-1390
Mailing address:
  • Phone: 734-879-1378
  • Fax: 734-879-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704161955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: