Basic Information
| Provider Information | |||||||||
| NPI: | 1316927841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENDRICK | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | LYNEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD | ||||||||
| Address2: | COMMANDER,USA-MEDDACK-AK,ATTEN:MCUC-MMD-QM | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073534107 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-QM | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 5902 | AK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.