MEDICARE: DAWN M BRICKER 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	102909	IA

General Provider Information

NPI Number	:	1790061612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M BRICKER FNP

Provider Business Mailing Address
First Line	:	1605 DOUGLAS ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51105-1109
Country	:	US
Telephone Number	:	712-234-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 DOUGLAS ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51105-1109
Country	:	US
Telephone Number	:	712-234-1005
Fax Number	:

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

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	07/25/2016

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