Provider Demographics
NPI:1205064045
Name:HOBSON, DELORIS REBECCA (NP)
Entity type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:REBECCA
Last Name:HOBSON
Suffix:
Gender:F
Credentials:NP
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-847-0572
Mailing Address - Fax:704-847-9760
Practice Address - Street 1:201 E MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5027
Practice Address - Country:US
Practice Address - Phone:704-847-0572
Practice Address - Fax:704-847-9760
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164246363LP0200X
NC300272363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005935Medicaid