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General NPI Number Information
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NPI Number | 1922403542
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Entity Type | Individual
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Provider Name | DAWN LISA LIDSTONE FNP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 76 CHURCH ST
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City | CANAAN
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State | CT
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Zip | 06018-2447
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Country | US
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Telephone | 860-624-0731
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | SOUTHFIELD
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State | MA
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Zip | 01259-0438
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Country | US
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Telephone | 413-854-1815
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 087663
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 284722
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 679700-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 007744
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License Number State | CT
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