Healthcare Provider Details

I. General information

NPI: 1083893358
Provider Name (Legal Business Name): PRISCILLA A DAWSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MISSION RD SUITE 207
KODIAK AK
99615-7327
US

IV. Provider business mailing address

316 MISSION RD SUITE 207
KODIAK AK
99615-7327
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-3319
  • Fax: 907-486-8149
Mailing address:
  • Phone: 907-486-3319
  • Fax: 907-486-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22101
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: