Healthcare Provider Details

I. General information

NPI: 1285597856
Provider Name (Legal Business Name): BREA DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 CAROLYN ST
KODIAK AK
99615-6376
US

IV. Provider business mailing address

323 CAROLYN ST
KODIAK AK
99615-6376
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-9800
  • Fax: 907-486-9808
Mailing address:
  • Phone: 907-486-9800
  • Fax: 907-486-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: