Healthcare Provider Details

I. General information

NPI: 1073903241
Provider Name (Legal Business Name): MRS. DAWN MARIE JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE JOHNS RN,BSN,NP-C

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N MAIN ST
O FALLON MO
63366-1746
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-687-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015001943
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015001943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: