Individual
CHRISTINE DERISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 VEST MILL CIR, WINSTON SALEM, NC 27103-2943
(336) 718-7800
(336) 718-7900
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125069058
IL
207Q00000X
Family Medicine Physician
Primary
2019-02192
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2016
Last updated
10/26/2020
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