Provider Demographics
NPI:1063401115
Name:HEABERLIN, DAWN G (CNM)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:G
Last Name:HEABERLIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:G
Other - Last Name:JOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5733
Mailing Address - Country:US
Mailing Address - Phone:515-239-4414
Mailing Address - Fax:515-239-4786
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5733
Practice Address - Country:US
Practice Address - Phone:515-239-4414
Practice Address - Fax:515-239-4786
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB058966367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419671Medicaid
IAS77494Medicare UPIN
IA0419671Medicaid