Healthcare Provider Details

I. General information

NPI: 1194781393
Provider Name (Legal Business Name): DAWNNE KARSKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 W VINE ST SUITE 22
LODI CA
95240-5144
US

IV. Provider business mailing address

DEPT 34577 PO BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 209-339-7435
  • Fax: 209-333-3054
Mailing address:
  • Phone: 209-339-7435
  • Fax: 209-333-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100965
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1513
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0292
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: