Dawn M. Derks ACNS-BC, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner in Saint Paul, MN(View on Map)
Full Name
Dawn Marie Derks ACNS-BC, PMHNP-BC
NPI Number
1396147377
NPI Type
Individual Provider
Gender
Female
Enumeration Date
09/21/2014
Specialties
(Taxonomies)Code
363LP0808X
364SA2200X
Primary Taxonomy
Yes
No
Licenses
State
Minnesota
Wisconsin
License Number
2014005854
15001-33
Contact
Information
Purpose
Mailing
Location
Address
1615 MAPLE LN
640 JACKSON ST
City
Ashland
Saint Paul
State
WI
MN
Postal Code
54806-3626
55101-2502
Country
US
US
Telephone Number
(715) 685-5500
(651) 254-3665
Identifiers
Identifier
C02467
Identifier State
MN
Identifier Issuer
MEDICARE
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 02/09/2024
Provider Address
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