Individual
MS. DAWN RENEE ANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1804 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(812) 288-6603
Mailing address
1804 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(812) 288-6603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002370A
IN
363LF0000X
Family Nurse Practitioner
71002370A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3007389
LICENSE NUMBER
KY
01
—
71002370A
LISENSURE NUMBER
IN
01
—
K162790
MEDICARE PTAN
KY
Enumeration date
04/13/2007
Last updated
09/30/2015
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