Healthcare Provider Details

I. General information

NPI: 1184744021
Provider Name (Legal Business Name): ROSALIND ELAINE DOCKERY I ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALIND ELAINE REECE I ADMINISTRATOR

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MOORE ST 288 6TH. ST.
ANDREWS NC
28901-9633
US

IV. Provider business mailing address

17 MOORE ST 288 6TH. ST.
ANDREWS NC
28901-9633
US

V. Phone/Fax

Practice location:
  • Phone: 828-321-9501
  • Fax: 828-321-9501
Mailing address:
  • Phone: 828-321-9501
  • Fax: 828-321-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberFCL-020-010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: