Provider Demographics
NPI:1174330518
Name:DAWSON, TRACEY AMBER (APRN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:AMBER
Last Name:DAWSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:AMBER
Other - Last Name:FINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 ISLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9207
Mailing Address - Country:US
Mailing Address - Phone:773-655-0442
Mailing Address - Fax:773-655-0442
Practice Address - Street 1:9551 171ST ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6109
Practice Address - Country:US
Practice Address - Phone:401-770-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily