Provider Demographics
NPI:1053621334
Name:GLOWATZ, DAWN MARII (APRN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARII
Last Name:GLOWATZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD STE 305
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2188
Mailing Address - Country:US
Mailing Address - Phone:513-232-3500
Mailing Address - Fax:513-624-2704
Practice Address - Street 1:8000 5 MILE RD STE 305
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2188
Practice Address - Country:US
Practice Address - Phone:513-232-3500
Practice Address - Fax:513-624-2704
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14429-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100141180Medicaid
KYP400035009Medicare PIN