Provider Demographics
NPI:1982649455
Name:MCKINNON, DAWN R (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND137056OtherUCARE #
ND19673Medicaid
ND1783082OtherAMERICA'S PPO/ARAZ #
ND46G75MCOtherMNBS #
ND20752OtherNDBS #
ND74G29MCOtherMNBS #
ND0119719OtherMEDICA #
NDDA9051028559OtherPREFERRED ONE #
ND6823190Medicaid
ND771193000Medicaid
NDHP38610OtherHEALTHPARTNERS #
ND19673Medicaid
ND137056OtherUCARE #
ND20752OtherNDBS #
ND1783082OtherAMERICA'S PPO/ARAZ #