MEDICARE: DAWN MARKS NAIL TECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	COS-CI-10177944	OR
2	261QP1100X	Podiatric Clinic/Center	COS-CI-10177944	OR
3	246Z00000X	Other Specialist/Technologist	COS-CI-10177944	OR

General Provider Information

NPI Number	:	1518697275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MARKS NAIL TECH

Provider Business Mailing Address
First Line	:	4105 SUMMERLINN DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5110
Country	:	US
Telephone Number	:	503-997-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	4105 SUMMERLINN DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5110
Country	:	US
Telephone Number	:	503-997-3703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/22/2022

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Directions to “ DAWN MARKS NAIL TECH” Practice Location

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