Provider Demographics
NPI:1184744021
Name:DOCKERY, ROSALIND ELAINE I (ADMINISTRATOR)
Entity type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:ELAINE
Last Name:DOCKERY
Suffix:I
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:MS
Other - First Name:ROSALIND
Other - Middle Name:ELAINE
Other - Last Name:REECE
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:17 MOORE ST
Mailing Address - Street 2:288 6TH. ST.
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-9633
Mailing Address - Country:US
Mailing Address - Phone:828-321-9501
Mailing Address - Fax:828-321-9501
Practice Address - Street 1:17 MOORE ST
Practice Address - Street 2:288 6TH. ST.
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-9633
Practice Address - Country:US
Practice Address - Phone:828-321-9501
Practice Address - Fax:828-321-9501
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-020-010376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803440Medicaid
NC7804207Medicaid