Provider Demographics
NPI:1376913194
Name:DAWSON-HARREL, MICHELLE KAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAYE
Last Name:DAWSON-HARREL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-435-9132
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:13075 W MCDOWELL RD
Practice Address - Street 2:SUITE D106
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6436
Practice Address - Country:US
Practice Address - Phone:623-547-0522
Practice Address - Fax:623-547-0521
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6200363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ072481Medicaid