Provider Demographics
NPI:1609928654
Name:DAWSON, BRENDA B (RN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:B
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HIGHWAY 580
Mailing Address - Street 2:
Mailing Address - City:TRANSYLVANIA
Mailing Address - State:LA
Mailing Address - Zip Code:71286-5811
Mailing Address - Country:US
Mailing Address - Phone:318-552-7685
Mailing Address - Fax:318-552-1844
Practice Address - Street 1:1401 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5513
Practice Address - Country:US
Practice Address - Phone:318-574-1713
Practice Address - Fax:318-574-2299
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN038698163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult