Healthcare Provider Details

I. General information

NPI: 1497068407
Provider Name (Legal Business Name): DAWN MCCOLLUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 SE 33RD WAY
GRESHAM OR
97080-8072
US

IV. Provider business mailing address

17136 SE KELLY ST
PORTLAND OR
97236-1249
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-9881
  • Fax:
Mailing address:
  • Phone: 503-285-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 60153323
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200941609RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: