MEDICARE: DAWSON KRAIN LOPEZ WHNP-BC, A-GPCNP-C

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	363LW0102X	Women's Health Nurse Practitioner	AP8005	AZ
2	363LA2200X	Adult Health Nurse Practitioner	AP8005	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740657923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWSON KRAIN LOPEZ WHNP-BC, A-GPCNP-C

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

Provider Business Practice Location Address
First Line	:	12635 W RUDASILL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-9724
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	04/28/2023

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