Provider Demographics
NPI:1306438585
Name:JEARDOE, DAWN (RN BSN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JEARDOE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3617
Mailing Address - Country:US
Mailing Address - Phone:402-223-1585
Mailing Address - Fax:402-223-1586
Practice Address - Street 1:201 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3617
Practice Address - Country:US
Practice Address - Phone:402-223-1585
Practice Address - Fax:402-223-1586
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse