Basic Information
| Provider Information | |||||||||
| NPI: | 1295798957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BLACK HAWK TRL | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287858392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042549535 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 606 WADE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276051390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194432360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | ARNP9222910 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 5007067 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.