Provider Demographics
NPI:1912238080
Name:BANKSON, DAWN RAE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RAE
Last Name:BANKSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:RAE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2592 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2608 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-312-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 9332363LP0200X
WARN60103201363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0262140OtherL&I AND CRIME VICTIMS
WA1396704324Medicaid
WA0398BAOtherREGENCE
WA0262140OtherL&I AND CRIME VICTIMS
WAG8891586Medicare PIN