Healthcare Provider Details

I. General information

NPI: 1992988943
Provider Name (Legal Business Name): IVORY TANU DAWSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 PINE TREE ST W APT D
COLUMBUS OH
43229-3784
US

IV. Provider business mailing address

5743 PINETREE STREET WEST APT. D
COLUMBUS OH
43229-3784
US

V. Phone/Fax

Practice location:
  • Phone: 614-208-3599
  • Fax:
Mailing address:
  • Phone: 614-208-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN334790
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN 334790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: