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General NPI Number Information
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NPI Number | 1518697275
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Entity Type | Individual
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Provider Name | DAWN MARKS NAIL TECH
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 4105 SUMMERLINN DR
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City | WEST LINN
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State | OR
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Zip | 97068-5110
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Country | US
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Telephone | 503-997-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 SUMMERLINN DR
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City | WEST LINN
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State | OR
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Zip | 97068-5110
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Country | US
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Telephone | 503-997-3703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | COS-CI-10177944
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | COS-CI-10177944
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | COS-CI-10177944
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License Number State | OR
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