Provider Demographics
NPI:1083905673
Name:DRAKE, DAWN MELISSA (RNP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MELISSA
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-854-2428
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:GILSTEIN SUITE/BAXT BUILDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-793-3922
Practice Address - Fax:401-435-7069
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00252363L00000X
RINPP37600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner