Provider Demographics
NPI:1730554973
Name:TRUDEAU, DAWN (RN,CAS, BCHP, IMD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:RN,CAS, BCHP, IMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LIGHTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4840
Mailing Address - Country:US
Mailing Address - Phone:508-633-9183
Mailing Address - Fax:
Practice Address - Street 1:2 CRANDALL RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-2646
Practice Address - Country:US
Practice Address - Phone:774-264-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-12
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269554163W00000X, 163WA0400X, 163WP0000X, 163WP0808X, 163WA0400X
RIRN44814163WG0100X, 171400000X, 261QI0500X, 171000000X, 261QI0500X, 171400000X
RI58126DIM175F00000X, 175F00000X
RI250494204202D00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171000000XOther Service ProvidersMilitary Health Care Provider