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General NPI Number Information
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NPI Number | 1679121347
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Entity Type | Individual
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Provider Name | DAWN M JECKELL BC-HIS
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Gender | Female
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD STE 311
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-341-7112
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Fax | 540-341-8361
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Provider Business Mailing Address
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Address Line | 10775 REYNARD FOX LN
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City | BEALETON
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State | VA
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Zip | 22712-6852
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Country | US
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Telephone | 540-316-8194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2101002051
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License Number State | VA
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