Provider Demographics
NPI:1962887604
Name:STEVENSON-REED, DAWN MICHELE (AGACNP - BC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:STEVENSON-REED
Suffix:
Gender:F
Credentials:AGACNP - BC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MICHELE
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2826 W LOCUST ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3354
Mailing Address - Country:US
Mailing Address - Phone:563-332-8528
Mailing Address - Fax:
Practice Address - Street 1:310 HOME BLVD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7408
Practice Address - Country:US
Practice Address - Phone:309-343-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH116754363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care