Provider Demographics
NPI:1093193831
Name:DONAHOE, DAKOTA SHAWN (PA-C)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:SHAWN
Last Name:DONAHOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:SHAWN
Other - Last Name:DOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8458
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:
Practice Address - Street 1:3860 CRATER LAKE AVE # A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9741
Practice Address - Country:US
Practice Address - Phone:541-858-1003
Practice Address - Fax:541-779-0986
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OR179569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant