Provider Demographics
NPI:1316360704
Name:REARDON, DAWN (ND)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6524
Mailing Address - Country:US
Mailing Address - Phone:360-385-3290
Mailing Address - Fax:360-385-2543
Practice Address - Street 1:1002 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6524
Practice Address - Country:US
Practice Address - Phone:360-385-3290
Practice Address - Fax:360-385-2543
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60443433175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath