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General NPI Number Information
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NPI Number | 1013715614
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Entity Type | Individual
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Provider Name | DAWN DEANNA TYSON-LIGGETT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1084 S MAIN ST STE A
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City | BOWLING GREEN
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State | OH
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Zip | 43402-4740
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Country | US
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Telephone | 419-352-4624
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Fax | 419-936-7606
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Provider Business Mailing Address
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Address Line | 1084 S MAIN ST STE A
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City | BOWLING GREEN
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State | OH
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Zip | 43402-4740
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Country | US
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Telephone | 419-352-4624
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Fax | 419-936-7606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN.510814
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License Number State | OH
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