Provider Demographics
NPI:1386343689
Name:VENMAN, DAWN (RD, LDN, CLC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VENMAN
Suffix:
Gender:F
Credentials:RD, LDN, CLC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2525 SWEDE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-3727
Mailing Address - Country:US
Mailing Address - Phone:814-706-6347
Mailing Address - Fax:
Practice Address - Street 1:2525 SWEDE HILL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-3727
Practice Address - Country:US
Practice Address - Phone:814-706-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174N00000X
PADN001423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN