Provider Demographics
NPI:1093836934
Name:ALLEN, DAWN MARY (NNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17079 CHERRY CREST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5946
Mailing Address - Country:US
Mailing Address - Phone:209-404-6765
Mailing Address - Fax:
Practice Address - Street 1:17079 CHERRY CREST AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5946
Practice Address - Country:US
Practice Address - Phone:209-404-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418590364SN0000X
OR200870015CNS364SN0000X
OR201050159NP363LN0005X
WAAP30006316363LN0005X
CA12884363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal