Provider Demographics
NPI:1033685169
Name:MASON, DAWN MICHELE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:MASON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1309
Mailing Address - Country:US
Mailing Address - Phone:509-747-5615
Mailing Address - Fax:509-747-5133
Practice Address - Street 1:26 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1309
Practice Address - Country:US
Practice Address - Phone:509-747-5615
Practice Address - Fax:509-747-5133
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60909981363LP0808X
WARN60083151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2110308Medicaid