Provider Demographics
NPI:1184204786
Name:KLEMARCZYK, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KLEMARCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SHATTUCK WAY
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7879
Mailing Address - Country:US
Mailing Address - Phone:603-436-0448
Mailing Address - Fax:603-436-0668
Practice Address - Street 1:177 SHATTUCK WAY
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7879
Practice Address - Country:US
Practice Address - Phone:603-436-0448
Practice Address - Fax:603-436-0668
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH027412-21163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH027412-21OtherRN