Provider Demographics
NPI:1679850614
Name:FERRISI, DAWN M (PA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:FERRISI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:LUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7337
Mailing Address - Country:US
Mailing Address - Phone:580-286-2600
Mailing Address - Fax:580-286-1087
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-222-5200
Practice Address - Fax:508-236-7335
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2043363A00000X
MAPA8700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant