Individual
DAWN R BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
117 CAMINO DE VIDA, SUITE 300, SANTA ROSA, NM 88435
(575) 472-4311
(575) 472-4313
Mailing address
117 CAMINO DE VIDA, SUITE 300, SANTA ROSA, NM 88435
(575) 472-4311
(575) 472-4313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2103
AK
363A00000X
Physician Assistant
PA.0003777
CO
363A00000X
Physician Assistant
Primary
PA2016-0044
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54452015
—
NM
Enumeration date
11/28/2005
Last updated
02/08/2017
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