Provider Demographics
NPI:1437145760
Name:MCCOMB, DAWN M (PA-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1211 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1909
Mailing Address - Country:US
Mailing Address - Phone:608-252-8000
Mailing Address - Fax:608-288-6495
Practice Address - Street 1:1211 FISH HATCHERY RD.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1909
Practice Address - Country:US
Practice Address - Phone:608-252-8000
Practice Address - Fax:608-288-6495
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1498-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437145760Medicaid
WI60827OtherDEAN HEALTH INSURANCE
WI41961900Medicaid
WI0441 71018Medicare PIN
WI0574 45300Medicare PIN
WI60827OtherDEAN HEALTH INSURANCE
WI104774150Medicare PIN