Provider Demographics
NPI:1063761245
Name:MC GINNIS, DAWN S
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:S
Last Name:MC GINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W296 N7083 TAMRON CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9256
Mailing Address - Country:US
Mailing Address - Phone:262-538-3833
Mailing Address - Fax:
Practice Address - Street 1:W296N7083 TAMRON CT
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9256
Practice Address - Country:US
Practice Address - Phone:262-538-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94884-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse