Provider Demographics
NPI:1013114362
Name:DAWKINS, NOREEN NADINE (PA)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:NADINE
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176-60 UNION TURNPIKE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1531
Mailing Address - Country:US
Mailing Address - Phone:718-460-2300
Mailing Address - Fax:347-225-9930
Practice Address - Street 1:176-60 UNION TURNPIKE
Practice Address - Street 2:SUITE 360
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1531
Practice Address - Country:US
Practice Address - Phone:718-460-2300
Practice Address - Fax:347-225-9930
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
330128Medicare UPIN