Provider Demographics
NPI:1417504721
Name:WOODS, DAWN MARIE (FNP-ADULT HEALTH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:WOODS
Suffix:
Gender:F
Credentials:FNP-ADULT HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W GATE DR APT 305
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4263
Mailing Address - Country:US
Mailing Address - Phone:845-234-7609
Mailing Address - Fax:
Practice Address - Street 1:3015 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2116
Practice Address - Country:US
Practice Address - Phone:845-234-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344699207R00000X
NY344699363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF344619OtherLICENSE
NC5013860OtherLICENSE