Provider Demographics
NPI:1336428143
Name:DOHN, MICHAEL C (RN, CDE)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:DOHN
Suffix:
Gender:M
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2231
Mailing Address - Country:US
Mailing Address - Phone:970-564-2490
Mailing Address - Fax:970-564-2134
Practice Address - Street 1:1311 N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2231
Practice Address - Country:US
Practice Address - Phone:970-564-2490
Practice Address - Fax:970-564-2134
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN287206163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH287206OtherLICENSE
2062-0132OtherDIABETIC EDUCATOR CERTIFICATION