Provider Demographics
NPI:1558027755
Name:VOGT, DAWN K (MICP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:VOGT
Suffix:
Gender:F
Credentials:MICP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7332
Mailing Address - Country:US
Mailing Address - Phone:907-232-1218
Mailing Address - Fax:
Practice Address - Street 1:4880 N BENCH VIEW DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9156
Practice Address - Country:US
Practice Address - Phone:907-232-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDM457146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic