Basic Information
| Provider Information | |||||||||
| NPI: | 1568643146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | LYN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 PINEHURST RD SE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871242219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058969412 | ||||||||
| FaxNumber: | 5058962505 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 PINEHURST RD SE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871242219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058969412 | ||||||||
| FaxNumber: | 5058962505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2007 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | R41741 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | CS00213187 | 01 | NM | CONTROLLED SUBSTANCE LIC | OTHER |