Healthcare Provider Details

I. General information

NPI: 1558301580
Provider Name (Legal Business Name): SHIRLEY J. DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 COUNTY ROAD A
GREEN LAKE WI
54941-8630
US

IV. Provider business mailing address

571 COUNTY ROAD A PO BOX 588
GREEN LAKE WI
54941-8630
US

V. Phone/Fax

Practice location:
  • Phone: 920-294-4070
  • Fax: 920-294-4139
Mailing address:
  • Phone: 920-294-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32276-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: