Healthcare Provider Details

I. General information

NPI: 1346403649
Provider Name (Legal Business Name): MS. DAWN MARGO CAYENNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 BERGEN AVE APT-BSMT
BROOKLYN NY
11234-5384
US

IV. Provider business mailing address

1072 BERGEN AVE APT-BSMT
BROOKLYN NY
11234-5384
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-3295
  • Fax:
Mailing address:
  • Phone: 718-444-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number531250
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number531250
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number531250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: