Healthcare Provider Details

I. General information

NPI: 1366644320
Provider Name (Legal Business Name): DAWN RENEE TOPE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S BISHOP AVE
ROLLA MO
65401-4311
US

IV. Provider business mailing address

17430 CLIFF RD
DIXON MO
65459-8245
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-5900
  • Fax: 573-426-4466
Mailing address:
  • Phone: 573-759-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number135472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: