Healthcare Provider Details

I. General information

NPI: 1053756767
Provider Name (Legal Business Name): ELIZABETH CAMERON GRIM DAWSON WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 GREENBRIER PKWY STE B
CHESAPEAKE VA
23320-3823
US

IV. Provider business mailing address

201 SALTWOOD CT
CHESAPEAKE VA
23320-6905
US

V. Phone/Fax

Practice location:
  • Phone: 757-548-2800
  • Fax:
Mailing address:
  • Phone: 757-846-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024170707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: