Provider Demographics
NPI:1700397783
Name:FAUSSETT, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:FAUSSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3322
Mailing Address - Country:US
Mailing Address - Phone:509-573-5118
Mailing Address - Fax:
Practice Address - Street 1:510 S 9TH ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-4617
Practice Address - Country:US
Practice Address - Phone:509-573-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60087368163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool