1295721785 NPI number — DAWN M NOWELL FNP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295721785 NPI number — DAWN M NOWELL FNP

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NOWELL

Provider First Name:

DAWN

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

FNP

Provider Gender Code:

F

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:

1295721785

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

9900 BREN RD E

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MINNETONKA

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55343-9664

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

563-210-0873

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5683 EVERGREEN PL

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BETTENDORF

Provider Business Practice Location Address State Name:

IA

Provider Business Practice Location Address Postal Code:

52722-5531

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

563-210-0873

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363LF0000X , with the licence number:  209003892 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LF0000X , with the licence number: A083201 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 309001343 . This is a "CONTROLLED SUBSTANCE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 421060724A7 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 02266 . This is a "IA BCBS SEEN IN DAVENPORT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 235624 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: P42667 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 078004 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5201205 . This is a "CONTROLLED SUBSTANCE#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 93109 . This is a "IA BCBS SEEN IN RI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 93082 . This is a "IA BCBS SEEN IN MOLINE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: IA01A7 . This is a "JOHN DEERE EDI#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 421060724 . This is a "BILLING TAX ID# FOR CHC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".