Provider Demographics
NPI:1467603142
Name:PACHAO, DOLOROSA TICSAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:DOLOROSA
Middle Name:TICSAY
Last Name:PACHAO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 RIVER PATH RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9735
Mailing Address - Country:US
Mailing Address - Phone:336-946-2909
Mailing Address - Fax:
Practice Address - Street 1:5630 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1312
Practice Address - Country:US
Practice Address - Phone:336-251-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily