Provider Demographics
NPI:1144393158
Name:PETROZIELLO, DAWN MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELLE
Last Name:PETROZIELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:MICHELLE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3812 THALIA DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2634
Mailing Address - Country:US
Mailing Address - Phone:808-428-0271
Mailing Address - Fax:757-412-1015
Practice Address - Street 1:968 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3171
Practice Address - Country:US
Practice Address - Phone:757-412-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant