=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275674509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH ANN DAWSON-WEISS CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 11/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 E BUTLER RD
-----------------------------------------------------
City | MAULDIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29662-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-234-1282
-----------------------------------------------------
Fax | 864-284-9826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 PEN DEL RD
-----------------------------------------------------
City | INMAN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29349-9253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-864-7601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | COA 08481 NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN.18286 RX
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------