Provider Demographics
NPI:1255584165
Name:SMITH, DAWN M (PA-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4202 W OAKWOOD PARK CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9118
Mailing Address - Country:US
Mailing Address - Phone:414-855-2800
Mailing Address - Fax:414-855-2801
Practice Address - Street 1:4202 W OAKWOOD PARK CT
Practice Address - Street 2:SUITE 120
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9118
Practice Address - Country:US
Practice Address - Phone:414-855-2800
Practice Address - Fax:414-855-2801
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI465-023363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255584165Medicaid