MEDICARE: JENNIFER DAWSON NRP, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1659834356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAWSON NRP, ATC

Provider Business Mailing Address
First Line	:	26908 E KARLYN LOOP PR NE
Second Line	:
City	:	BENTON CITY
State	:	WA
Zip	:	99320-8887
Country	:	US
Telephone Number	:	509-308-0286
Fax Number	:

Provider Business Practice Location Address
First Line	:	26908 E KARLYN LOOP PR NE
Second Line	:
City	:	BENTON CITY
State	:	WA
Zip	:	99320-8887
Country	:	US
Telephone Number	:	509-308-0286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/09/2019

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