Provider Demographics
NPI:1750071890
Name:MOURY, DAWN (MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MOURY
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROCK FORGE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6262
Mailing Address - Country:US
Mailing Address - Phone:304-282-3048
Mailing Address - Fax:
Practice Address - Street 1:140 ROCK FORGE LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-6262
Practice Address - Country:US
Practice Address - Phone:304-282-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV59579163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health