Provider Demographics
NPI:1609108398
Name:CABBAGE, DAWSON B (CRNA)
Entity Type:Individual
Prefix:
First Name:DAWSON
Middle Name:B
Last Name:CABBAGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 VISTA LOOP SW APT 33-102
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8325
Mailing Address - Country:US
Mailing Address - Phone:206-227-8868
Mailing Address - Fax:
Practice Address - Street 1:1541 VISTA LOOP SW APT 33-102
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-8325
Practice Address - Country:US
Practice Address - Phone:206-227-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD177487367500000X
WAAP60134957367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered