Healthcare Provider Details

I. General information

NPI: 1487262762
Provider Name (Legal Business Name): CHRISTINA DISHMOND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20808 N MAIN ST STE 102
CORNELIUS NC
28031-8496
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 704-765-4430
  • Fax: 704-705-2772
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013316
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: