Healthcare Provider Details

I. General information

NPI: 1841212321
Provider Name (Legal Business Name): DAWN LOVISA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S MAIN ST PREVEA OCONTO FALLS HEALTH CENTER
OCONTO FALLS WI
54154-1282
US

IV. Provider business mailing address

PO BOX 1242
BAYFIELD WI
54814-1242
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-8187
  • Fax:
Mailing address:
  • Phone: 715-209-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201381-7
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1779-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: