Provider Demographics
NPI:1154683886
Name:PHILP, DAWN (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:PHILP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10159 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3857
Mailing Address - Country:US
Mailing Address - Phone:619-444-3264
Mailing Address - Fax:619-331-3717
Practice Address - Street 1:10159 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3857
Practice Address - Country:US
Practice Address - Phone:619-444-3264
Practice Address - Fax:619-331-3717
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner