Provider Demographics
NPI:1295774750
Name:DE VILMORIN, NINA LISETTE (MD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:LISETTE
Last Name:DE VILMORIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603366
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3366
Mailing Address - Country:US
Mailing Address - Phone:240-566-1600
Mailing Address - Fax:240-566-1605
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-2325
Practice Address - Fax:828-213-2311
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01341207L00000X
MT148229207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93702Medicare UPIN
CA00G766070Medicare ID - Type Unspecified
CA00G766070Medicaid