Provider Demographics
NPI:1548463870
Name:ROSS, DOROTHY RENEE HENRY (NP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:RENEE HENRY
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:RENEE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3758 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1959
Mailing Address - Country:US
Mailing Address - Phone:910-429-0647
Mailing Address - Fax:910-429-0791
Practice Address - Street 1:3758 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1959
Practice Address - Country:US
Practice Address - Phone:910-429-0647
Practice Address - Fax:910-429-0791
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002805202C00000X
NC5002805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner