Provider Demographics
NPI:1235687419
Name:DORIC, WENDY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DORIC
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-883-8262
Mailing Address - Fax:704-883-8252
Practice Address - Street 1:276 OLD MOCKSVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1949
Practice Address - Country:US
Practice Address - Phone:704-883-8262
Practice Address - Fax:704-883-8252
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily