Individual
DEBORAH H NIFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1901 S HAWTHORNE RD, SUITE 210, WINSTON SALEM, NC 27103-3921
(336) 718-5000
Mailing address
2085 FRONTIS PLAZA BLVD, WINSTON SALEM, NC 27103-5614
(336) 277-7226
(336) 277-9795
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200176
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7003880
—
NC
Enumeration date
11/01/2006
Last updated
06/14/2011
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