Provider Demographics
NPI:1861027278
Name:DORAN, REBECCA (DNP, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DORAN
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3133
Mailing Address - Country:US
Mailing Address - Phone:304-573-5898
Mailing Address - Fax:
Practice Address - Street 1:1103 N ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6312
Practice Address - Country:US
Practice Address - Phone:336-272-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25701363LP0200X
NC5016323363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics