Provider Demographics
NPI:1639164122
Name:DOTSON, WENDY ANN (CNM)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:DOTSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:SCHUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:12129 GRAHAM MEADOWS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6661
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-282-2601
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024138899367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639164122Medicaid
VA010024404Medicaid
P32113Medicare UPIN
VA1639164122Medicaid
VA014649L19Medicare PIN
VAQ53301AMedicare PIN