Healthcare Provider Details

I. General information

NPI: 1295254498
Provider Name (Legal Business Name): DAWN MCILWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST
EUGENE OR
97401-2612
US

IV. Provider business mailing address

2222 COBURG RD
EUGENE OR
97401-4966
US

V. Phone/Fax

Practice location:
  • Phone: 541-337-1515
  • Fax:
Mailing address:
  • Phone: 541-687-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

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: