Provider Demographics
NPI:1992988943
Name:DAWSON, IVORY TANU (RN)
Entity type:Individual
Prefix:MS
First Name:IVORY
Middle Name:TANU
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 PINETREE STREET WEST
Mailing Address - Street 2:APT. D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3784
Mailing Address - Country:US
Mailing Address - Phone:614-208-3599
Mailing Address - Fax:
Practice Address - Street 1:5743 PINE TREE ST W
Practice Address - Street 2:APT D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3784
Practice Address - Country:US
Practice Address - Phone:614-208-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN334790163WH0200X
OHRN 334790163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical