Provider Demographics
NPI:1528172202
Name:MCNERNEY, DAWN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:RATHBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:21 BRISTOL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1199
Mailing Address - Country:US
Mailing Address - Phone:860-458-9699
Mailing Address - Fax:
Practice Address - Street 1:21 BRISTOL DR
Practice Address - Street 2:STE 100
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1199
Practice Address - Country:US
Practice Address - Phone:860-458-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00573363A00000X
CT001785363AM0700X
MA2419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty