MEDICARE: MS. JUDITH ANN DAWSON-WEISS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA 08481 NP	OH
2	363LF0000X	Family Nurse Practitioner	APN.18286 RX	SC

General Provider Information

NPI Number	:	1275674509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ANN DAWSON-WEISS CNP

Provider Business Mailing Address
First Line	:	709 PEN DEL RD
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-9253
Country	:	US
Telephone Number	:	440-864-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 E BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2129
Country	:	US
Telephone Number	:	864-234-1282
Fax Number	:	864-284-9826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	11/24/2014

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