Individual
ELIZABETH DIANE DASSOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 S MAIN ST, FAIRFIELD, IA 52556-9572
(641) 469-4204
Mailing address
2233 W HILLS DR, FAIRFIELD, IA 52556-4739
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085007694
IL
363AM0700X
Medical Physician Assistant
Primary
106586
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/03/2020
Last updated
12/07/2022
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