Healthcare Provider Details

I. General information

NPI: 1215018338
Provider Name (Legal Business Name): BONNIE JANE DAWSON RN, MSN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR VAMC, PPH
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR VAMC, PPH
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-3622
  • Fax: 612-467-5309
Mailing address:
  • Phone: 612-467-3622
  • Fax: 612-467-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR092038-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR 092038-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: