Healthcare Provider Details

I. General information

NPI: 1104888049
Provider Name (Legal Business Name): DAWN RENEE ROWDER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 S 52ND ST
MILWAUKEE WI
53220-3205
US

IV. Provider business mailing address

29225 N LAKE DR
WATERFORD WI
53185-1161
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-1602
  • Fax:
Mailing address:
  • Phone: 262-895-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number139950-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: