Provider Demographics
NPI:1215651823
Name:RAMIREZ BALLESTEROS, DORA MARCELA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:MARCELA
Last Name:RAMIREZ BALLESTEROS
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 1:790 BELL FARM RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8517
Mailing Address - Country:US
Mailing Address - Phone:704-929-8548
Mailing Address - Fax:
Practice Address - Street 1:276 OLD MOCKSVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1950
Practice Address - Country:US
Practice Address - Phone:704-883-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRAMI-KYR2K363LF0000X
NC5016976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily