Provider Demographics
NPI:1255922167
Name:DAWSON, BRITTANY JACLIN (PA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JACLIN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:JACLIN
Other - Last Name:LABRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3862 SURFSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9060
Mailing Address - Country:US
Mailing Address - Phone:330-319-4142
Mailing Address - Fax:
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-285-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant