MEDICARE: NANCY LAVON DAWSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP2366	AZ
2	363LF0000X	Family Nurse Practitioner	71002847A	IN

General Provider Information

NPI Number	:	1598794935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LAVON DAWSON FNP

Provider Business Mailing Address
First Line	:	5102 E PIEDMONT RD APT 2235
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-8619
Country	:	US
Telephone Number	:	480-766-1142
Fax Number	:

Provider Business Practice Location Address
First Line	:	5102 E PIEDMONT RD APT 2235
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-8619
Country	:	US
Telephone Number	:	480-766-1142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/02/2009

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