Healthcare Provider Details

I. General information

NPI: 1205064045
Provider Name (Legal Business Name): DELORIS REBECCA HOBSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MATTHEWS ST
MATTHEWS NC
28105-5027
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-0572
  • Fax: 704-847-9760
Mailing address:
  • Phone: 704-847-0572
  • Fax: 704-847-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number164246
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300272
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number300272
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: