Healthcare Provider Details

I. General information

NPI: 1457212276
Provider Name (Legal Business Name): DAWN J HASKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

IV. Provider business mailing address

601 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-7930
  • Fax: 541-426-2660
Mailing address:
  • Phone: 541-426-7930
  • Fax: 541-426-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number114762
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: