Provider Demographics
NPI:1518974443
Name:BROCK, RHONDA K (BSN, RN, WOC, CFM)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:K
Last Name:BROCK
Suffix:
Gender:F
Credentials:BSN, RN, WOC, CFM
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 11348
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-1348
Mailing Address - Country:US
Mailing Address - Phone:336-896-0408
Mailing Address - Fax:336-896-0409
Practice Address - Street 1:8007 N POINT BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3268
Practice Address - Country:US
Practice Address - Phone:336-896-0408
Practice Address - Fax:336-896-0409
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC052983163W00000X
224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795454Medicaid