Provider Demographics
NPI:1871080267
Name:WALL, DAWN MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:WALL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:9412 S COLLEGE AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5240
Mailing Address - Country:US
Mailing Address - Phone:918-863-4076
Mailing Address - Fax:
Practice Address - Street 1:2929 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5101
Practice Address - Country:US
Practice Address - Phone:918-665-1520
Practice Address - Fax:918-663-8435
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002902363L00000X
MO2018006691363LF0000X
OK215785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner