Provider Demographics
NPI:1053756767
Name:DAWSON, ELIZABETH CAMERON GRIM (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CAMERON GRIM
Last Name:DAWSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SALTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6905
Mailing Address - Country:US
Mailing Address - Phone:757-846-0914
Mailing Address - Fax:
Practice Address - Street 1:817 GREENBRIER PKWY STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3823
Practice Address - Country:US
Practice Address - Phone:757-548-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170707363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024170707OtherLICENSE NUMBER