Provider Demographics
NPI:1720661507
Name:DODD, DEIDRA RENEE (BSN, DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:RENEE
Last Name:DODD
Suffix:
Gender:F
Credentials:BSN, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT ROAD WOMACK ARMY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-7673
Mailing Address - Fax:910-907-5318
Practice Address - Street 1:BLDG. 2-1959
Practice Address - Street 2:2864 WOODRUFF STREET
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28311
Practice Address - Country:US
Practice Address - Phone:910-907-7673
Practice Address - Fax:910-907-5318
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC006955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily