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General NPI Number Information
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NPI Number | 1477592301
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Entity Type | Individual
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Provider Name | DAWN TIEDEMANN APRN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 455 LEWIS AVENUE SUITE 220
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City | MERIDEN
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State | CT
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Zip | 06451
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Country | US
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Telephone | 203-238-7747
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Fax | 203-686-0282
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Provider Business Mailing Address
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Address Line | 19 LUNAR DRIVE
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City | WOODBRIDGE
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State | CT
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Zip | 06525
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Country | US
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Telephone | 203-389-7504
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Fax | 203-389-1666
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 001916
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 364SX0200X
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Taxonomy Name | Oncology Clinical Nurse Specialist
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License Number | 001916
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License Number State | CT
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