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General NPI Number Information
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NPI Number | 1083132732
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Entity Type | Organization
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Legal Business Name | DAWSON OLIVER
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 09/01/2017
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Provider Practice Location Address
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Address Line | 7090 N ORACLE RD STE 80
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City | TUCSON
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State | AZ
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Zip | 85704-4344
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Country | US
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Telephone | 520-487-1114
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Fax | 520-844-6404
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Provider Business Mailing Address
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Address Line | 11257 W RUDDY DR
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City | MARANA
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State | AZ
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Zip | 85653-7726
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Country | US
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Telephone | 520-780-4253
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Fax | 520-844-6404
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Authorized Official
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Title or Position | OWNER
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Name | DAWSON KRAIN OLIVER
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Credential | WHNP-BC
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Telephone | 520-780-4253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP8005
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License Number State | AZ
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