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General NPI Number Information
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NPI Number | 1487262945
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Entity Type | Organization
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Legal Business Name | DOGWOOD LIFESTYLE MEDICINE PLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 08/21/2022
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Provider Practice Location Address
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Address Line | 4414 LAFAYETTE BLVD STE 239B
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-4271
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Country | US
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Telephone | 540-212-9525
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Fax | 540-779-7696
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Provider Business Mailing Address
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Address Line | 4414 LAFAYETTE BLVD STE 239B
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-4271
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Country | US
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Telephone | 540-212-9525
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Fax | 540-779-7696
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JONATHAN YODER
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Credential | NP-C
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Telephone | 540-212-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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