Provider Demographics
NPI:1396723557
Name:MILLARD, DAWN M (PAC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BLAIRSFERRY XING
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-7986
Mailing Address - Country:US
Mailing Address - Phone:319-393-0783
Mailing Address - Fax:319-393-0427
Practice Address - Street 1:400 S BLAIRSFERRY XING
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-7986
Practice Address - Country:US
Practice Address - Phone:319-393-0783
Practice Address - Fax:319-393-0427
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPO00004955OtherRR MEDICARE
IAI9223Medicare ID - Type Unspecified
IAPO00004955OtherRR MEDICARE