Provider Demographics
NPI:1427025170
Name:KORF, DAWN R (PA-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:KORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PENNSYLVANIA AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4779
Mailing Address - Country:US
Mailing Address - Phone:575-208-2509
Mailing Address - Fax:575-265-1700
Practice Address - Street 1:400 N PENNSYLVANIA AVE STE 920
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4779
Practice Address - Country:US
Practice Address - Phone:575-208-2509
Practice Address - Fax:575-265-1700
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090408363AM0700X
MT59062363AM0700X
AZPA2018-0089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical