Provider Demographics
NPI:1295798957
Name:DORN, REBECCA E (ARNP)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:E
Last Name:DORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BLACK HAWK TRL
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-8392
Mailing Address - Country:US
Mailing Address - Phone:904-254-9535
Mailing Address - Fax:
Practice Address - Street 1:606 WADE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1390
Practice Address - Country:US
Practice Address - Phone:919-443-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9222910163WP0808X
NC5007067363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4791AMedicare PIN
FLQ43919Medicare UPIN