Healthcare Provider Details

I. General information

NPI: 1053717686
Provider Name (Legal Business Name): DIONNE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N SALISBURY ST
LEXINGTON NC
27292-3548
US

IV. Provider business mailing address

4260 JULIUS CT
GREENSBORO NC
27406-8594
US

V. Phone/Fax

Practice location:
  • Phone: 336-243-7475
  • Fax: 336-249-6771
Mailing address:
  • Phone: 336-587-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200926
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: