Healthcare Provider Details

I. General information

NPI: 1497041115
Provider Name (Legal Business Name): DAWN NICHOLE LONG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 PINTO LN STE 200
LAS VEGAS NV
89106-4007
US

IV. Provider business mailing address

2011 PINTO LN STE 200
LAS VEGAS NV
89106-4007
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-3200
  • Fax: 702-382-3575
Mailing address:
  • Phone: 702-382-3200
  • Fax: 702-382-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number328181
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number622
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number828524
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: