Provider Demographics
NPI:1386022911
Name:WOMBLE, DAWN C (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:C
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:C
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:601 N. MECHANIC STREET SUITE AB
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-653-8321
Mailing Address - Fax:
Practice Address - Street 1:601 N. MECHANIC STREET SUITE AB
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-653-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001129705163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0178380595Medicaid