Provider Demographics
NPI:1487262945
Name:DOGWOOD LIFESTYLE MEDICINE PLC
Entity type:Organization
Organization Name:DOGWOOD LIFESTYLE MEDICINE PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:540-212-9525
Mailing Address - Street 1:4414 LAFAYETTE BLVD STE 239B
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4271
Mailing Address - Country:US
Mailing Address - Phone:540-212-9525
Mailing Address - Fax:540-779-7696
Practice Address - Street 1:4414 LAFAYETTE BLVD STE 239B
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4271
Practice Address - Country:US
Practice Address - Phone:540-212-9525
Practice Address - Fax:540-779-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty