Basic Information
| Provider Information | |||||||||
| NPI: | 1548771751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODSON | ||||||||
| FirstName: | JOHNATHAN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1429 SKI GAP RD | ||||||||
| Address2: | |||||||||
| City: | CLAYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166258018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143123120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148892011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2017 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN606961 | PA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LC0200X | SP018285 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.