Provider Demographics
NPI:1285277376
Name:DAWSON, STEPHANIE RENEA (CBS, PCD(DONA))
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:CBS, PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 BLOOMFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-8204
Mailing Address - Country:US
Mailing Address - Phone:859-797-1068
Mailing Address - Fax:888-299-6337
Practice Address - Street 1:3838 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1980
Practice Address - Country:US
Practice Address - Phone:863-680-2229
Practice Address - Fax:888-299-6337
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN