Provider Demographics
NPI:1083002729
Name:UNDERWOOD, DAWN R
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:R
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6356 S HALLIE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-8853
Mailing Address - Country:US
Mailing Address - Phone:907-671-3517
Mailing Address - Fax:
Practice Address - Street 1:360 W BENSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3953
Practice Address - Country:US
Practice Address - Phone:907-268-2327
Practice Address - Fax:510-355-1627
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily