Healthcare Provider Details

I. General information

NPI: 1588022313
Provider Name (Legal Business Name): DION GLENN TOMER RN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N MECKLENBURG AVE
SOUTH HILL VA
23970-4080
US

IV. Provider business mailing address

PO BOX 35
BLACKSTONE VA
23824-0035
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3151
  • Fax: 434-584-5023
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: