Darrell Lee Dedeaux
Nurse Practitioner - Primary Care
380 Knollwood St # 505
Winston Salem
, North Carolina 27103-1884
Darrell Lee Dedeaux
Nurse Practitioner - Primary Care
380 Knollwood St # 505
Winston Salem
, North Carolina 27103-1884
(910) 814-5727
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About
Features
Specialties
- Nurse Practitioner - Primary Care
Languages spoken
- English
Location
First Address
- Darrell Lee Dedeaux
- 129 T.t. Lanier Street
- Buies Creek, NC
- Zip : 27506
- Fax : (910) 814-5727
- Phone : (910) 893-1562
Second Address
- Darrell Lee Dedeaux
- 380 Knollwood St # 505
- Winston Salem, NC
- Zip : 27103-1884
- Phone : (833) 357-2966
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP2300X | Nurse Practitioner - Primary Care | 116077 | NC |
National Provider Identifier
| NPI | 1023556461 |
|---|---|
| Provider Name | Darrell Lee Dedeaux |
| First Address | Buies Creek, NC 27506 |
| Second Address | Winston Salem, NC 27103-1884 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/02/2017 |
| Last Update Date | 25/10/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.