Healthcare Provider Details

I. General information

NPI: 1013345032
Provider Name (Legal Business Name): VIBHABEN DHOLAKIA AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

1001 PEMBERTON HILL RD
APEX NC
27502-4265
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-1901
  • Fax:
Mailing address:
  • Phone: 919-362-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013008050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: