Provider Demographics
NPI:1386895654
Name:SMITH, DAWN PEARL (LPN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:PEARL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1525
Mailing Address - Country:US
Mailing Address - Phone:765-506-2553
Mailing Address - Fax:765-677-1970
Practice Address - Street 1:419 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1525
Practice Address - Country:US
Practice Address - Phone:765-506-2553
Practice Address - Fax:765-677-1970
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27047798A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse