Healthcare Provider Details

I. General information

NPI: 1093836934
Provider Name (Legal Business Name): DAWN MARY ALLEN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17079 CHERRY CREST AVE
LAKE OSWEGO OR
97034-5946
US

IV. Provider business mailing address

17079 CHERRY CREST AVE
LAKE OSWEGO OR
97034-5946
US

V. Phone/Fax

Practice location:
  • Phone: 209-404-6765
  • Fax:
Mailing address:
  • Phone: 209-404-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number201050159NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP30006316
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number12884
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number418590
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number200870015CNS
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: