Provider Demographics
NPI:1053625236
Name:HEZEL, DAWN M (NP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:HEZEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1375
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-1375
Mailing Address - Country:US
Mailing Address - Phone:716-725-1003
Mailing Address - Fax:716-226-5231
Practice Address - Street 1:2701 TRANSIT RD STE 141
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9399
Practice Address - Country:US
Practice Address - Phone:716-896-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382151363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF382151OtherNYS LICENSE