Provider Demographics
NPI:1942950050
Name:MARTIN, DAWN PHELPS (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:PHELPS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2289 SPRING GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SPOUT SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24593-2603
Mailing Address - Country:US
Mailing Address - Phone:434-610-1497
Mailing Address - Fax:
Practice Address - Street 1:800 OAK STREET
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001164576163WE0003X
VA0024184093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency