Provider Demographics
NPI:1194907790
Name:JENISON, DAWN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:JENISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:TOBOJKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:152 RODMAN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-7549
Mailing Address - Country:US
Mailing Address - Phone:401-339-8145
Mailing Address - Fax:
Practice Address - Street 1:208 COLLYER ST
Practice Address - Street 2:THORACIC AND CARDIOVASCULAR SURGICAL CENTER
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1560
Practice Address - Country:US
Practice Address - Phone:401-350-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA-00304363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical