Healthcare Provider Details

I. General information

NPI: 1386029163
Provider Name (Legal Business Name): JENNIFER DAWSON D'ANDREA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

IV. Provider business mailing address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2290
  • Fax:
Mailing address:
  • Phone: 702-990-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60591634
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60591634
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number816422
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0715892
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: