Provider Demographics
NPI:1063147981
Name:DAWSON, JOHANNA FRANCIS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:FRANCIS
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3109
Mailing Address - Country:US
Mailing Address - Phone:916-773-3376
Mailing Address - Fax:916-773-3353
Practice Address - Street 1:1535 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3109
Practice Address - Country:US
Practice Address - Phone:916-773-3376
Practice Address - Fax:916-773-3353
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA63207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program