Basic Information
| Provider Information | |||||||||
| NPI: | 1801809470 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PERSON | ||||||||
| FirstName: | DAWNETTE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 241011 | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952419511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093397825 | ||||||||
| FaxNumber: | 2093397528 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 TRINITY PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099480808 | ||||||||
| FaxNumber: | 2099480807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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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 | 363LF0000X | RN470138 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.