Provider Demographics
NPI:1275918351
Name:WOOD, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:ANGOON
Mailing Address - State:AK
Mailing Address - Zip Code:99820-0290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 RELAY ROAD
Practice Address - Street 2:
Practice Address - City:ANGOON
Practice Address - State:AK
Practice Address - Zip Code:99820
Practice Address - Country:US
Practice Address - Phone:907-788-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15-130-PDHA II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker