Healthcare Provider Details

I. General information

NPI: 1770988016
Provider Name (Legal Business Name): MALINDA DOCKRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E FRANKLIN ST
MONROE NC
28112-5160
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR
CONCORD NC
28025-1831
US

V. Phone/Fax

Practice location:
  • Phone: 704-283-6040
  • Fax:
Mailing address:
  • Phone: 843-680-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number206795
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: