1518965334 NPI number — DAWN B. LEWELLEN CRNA

Table of content: DAWN B. LEWELLEN CRNA (NPI 1518965334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518965334 NPI number — DAWN B. LEWELLEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWELLEN
Provider First Name:
DAWN
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518965334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 HICKORY VALLEY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76006-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-469-8107
Provider Business Mailing Address Fax Number:
817-265-3372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
DEPT. OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-590-8329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  252781 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)