Provider Demographics
NPI:1952890824
Name:DORMON, PEACE DZIGBORDI
Entity Type:Individual
Prefix:
First Name:PEACE
Middle Name:DZIGBORDI
Last Name:DORMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5695 NEW AVEDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8399
Mailing Address - Country:US
Mailing Address - Phone:336-790-2850
Mailing Address - Fax:
Practice Address - Street 1:5695 NEW AVEDON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8399
Practice Address - Country:US
Practice Address - Phone:336-790-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily