Healthcare Provider Details

I. General information

NPI: 1013535079
Provider Name (Legal Business Name): PATRICIA LEE DAWSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3864 JAMES MADISON HWY
FORK UNION VA
23055-2307
US

IV. Provider business mailing address

3864 JAMES MADISON HWY
FORK UNION VA
23055-2307
US

V. Phone/Fax

Practice location:
  • Phone: 434-989-7643
  • Fax:
Mailing address:
  • Phone: 434-989-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00241555
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: