Provider Demographics
NPI:1316353055
Name:FAIRBURN, DAWN E (NP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:FAIRBURN
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5570
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1152 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105
Practice Address - Country:US
Practice Address - Phone:765-522-1889
Practice Address - Fax:765-522-3583
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2021-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71004960A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201235230Medicaid
IN715320010Medicare PIN