Healthcare Provider Details

I. General information

NPI: 1528172202
Provider Name (Legal Business Name): DAWN MARIE MCNERNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN MARIE RATHBONE PA-C

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BRISTOL DR STE 100
SOUTH EASTON MA
02375-1199
US

IV. Provider business mailing address

21 BRISTOL DR STE 100
SOUTH EASTON MA
02375-1199
US

V. Phone/Fax

Practice location:
  • Phone: 860-458-9699
  • Fax:
Mailing address:
  • Phone: 860-458-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00573
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001785
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: