Provider Demographics
NPI:1194781393
Name:KARSKY, DAWNNE (PA)
Entity type:Individual
Prefix:
First Name:DAWNNE
Middle Name:
Last Name:KARSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34577
Mailing Address - Street 2:PO BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:209-339-7435
Mailing Address - Fax:209-333-3054
Practice Address - Street 1:1235 W VINE ST
Practice Address - Street 2:SUITE 22
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5144
Practice Address - Country:US
Practice Address - Phone:209-339-7435
Practice Address - Fax:209-333-3054
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100965363A00000X
NVPA1513363A00000X
NVPA0292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04FYOtherBC/BS
FL290801800Medicaid
FL290801800Medicaid