Individual
DAWN MARIE DERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNS-BC, PMHNP-BC
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3665
Mailing address
1615 MAPLE LN, ASHLAND, WI 54806-3626
(715) 685-5500
(715) 682-4022
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
15001-33
WI
364SA2200X
Adult Health Clinical Nurse Specialist
2014005854
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02467
MEDICARE
MN
Enumeration date
09/21/2014
Last updated
02/09/2024
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