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General NPI Number Information
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NPI Number | 1417159716
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Entity Type | Individual
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Provider Name | DAWN DIANE WARD LMT
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21 MILLER AVE
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City | SHOREHAM
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State | NY
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Zip | 11786-1803
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Country | US
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Telephone | 631-375-8828
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 872
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City | SHOREHAM
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State | NY
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Zip | 11786-0872
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Country | US
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Telephone | 631-375-8828
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 010397
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License Number State | NY
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