Healthcare Provider Details

I. General information

NPI: 1679850614
Provider Name (Legal Business Name): DAWN M FERRISI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN M LUCIER

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST
ATTLEBORO MA
02703-3143
US

IV. Provider business mailing address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-5200
  • Fax: 508-236-7335
Mailing address:
  • Phone: 580-286-2600
  • Fax: 580-286-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2043
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8700
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: