Provider Demographics
NPI:1255095626
Name:WEATHERWAX, DAWN MICHELE (RD,LD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:WEATHERWAX
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 LIBERTY CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9538
Mailing Address - Country:US
Mailing Address - Phone:513-779-6444
Mailing Address - Fax:
Practice Address - Street 1:6659 LIBERTY CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9538
Practice Address - Country:US
Practice Address - Phone:513-779-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4314133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered