Provider Demographics
NPI:1225446198
Name:POMAIBO, DAWN (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:POMAIBO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2939
Mailing Address - Country:US
Mailing Address - Phone:724-610-8878
Mailing Address - Fax:
Practice Address - Street 1:210 WELDON ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1848
Practice Address - Country:US
Practice Address - Phone:724-539-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily