Provider Demographics
NPI:1801560131
Name:BRICOLO, DORINDA (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:DORINDA
Middle Name:
Last Name:BRICOLO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5234 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-8492
Mailing Address - Country:US
Mailing Address - Phone:336-391-6332
Mailing Address - Fax:
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-716-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBRIC-AZ9A6363LP0200X
NC5014680363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics