Back, Dawn R

Back, Dawn R is an individual health care provider with primary practice located at 117 Camino De Vida Suite 300, Santa Rosa NM 88435. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Back, Dawn R can be contacted via phone (575) 472-4311.

Contact Information

Primary practice address
117 Camino De Vida Suite 300 Santa Rosa NM 88435
Phone: (575) 472-4311
Fax: (575) 472-4313
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2016-0044 New Mexico
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2103 Alaska
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.0003777 Colorado

Profile Details

NPI number 1841273554
LBN Legal business name Back, Dawn R
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 28th, 2005
Last updated Feb 8th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841273554 NPPES
New Mexico MEDICAID 54452015

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