Provider Demographics
NPI:1619716388
Name:MCDERMOTT, DAWN RAE (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RAE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 9TH CT SE
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-9419
Mailing Address - Country:US
Mailing Address - Phone:503-930-4623
Mailing Address - Fax:
Practice Address - Street 1:7595 9TH CT SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9419
Practice Address - Country:US
Practice Address - Phone:503-930-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-124093163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant