Provider Demographics
NPI:1861156291
Name:SODDERS, DAWN MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:SODDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3050 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5375
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-215-9397
Practice Address - Street 1:3050 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5375
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-215-9397
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-11-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical