Provider Demographics
NPI:1790021814
Name:LABARBERA, DAWN M (PA-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:LABARBERA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:2512 E DUPONT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1609
Practice Address - Country:US
Practice Address - Phone:260-497-0084
Practice Address - Fax:260-484-2859
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2020-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10001453A363A00000X
IL085000642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN260690008Medicare PIN