Provider Demographics
NPI:1821187998
Name:CRESENZO-DISHMON, FRANCES HOUGH (CNM)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:HOUGH
Last Name:CRESENZO-DISHMON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-4652
Mailing Address - Country:US
Mailing Address - Phone:336-342-6063
Mailing Address - Fax:336-342-7847
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4652
Practice Address - Country:US
Practice Address - Phone:336-342-6063
Practice Address - Fax:336-342-6066
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10386367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821187998Medicaid
151YJOtherBCBS INDIVIDUAL
151YJOtherBCBS INDIVIDUAL