Provider Demographics
NPI:1073653861
Name:DAWSON, MARTIN ANDREW (NP)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ANDREW
Last Name:DAWSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2865 CHURN CREEK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1117
Mailing Address - Country:US
Mailing Address - Phone:530-646-7269
Mailing Address - Fax:530-275-2201
Practice Address - Street 1:2865 CHURN CREEK RD
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1117
Practice Address - Country:US
Practice Address - Phone:530-646-7269
Practice Address - Fax:530-275-2201
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP14942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59053Medicare UPIN