Provider Demographics
NPI:1003799800
Name:DIEUBON-DESSALINES, NIRVA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NIRVA
Middle Name:
Last Name:DIEUBON-DESSALINES
Suffix:
Gender:X
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 UNIVERSITY EAST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3971
Mailing Address - Country:US
Mailing Address - Phone:980-704-6670
Mailing Address - Fax:980-201-9605
Practice Address - Street 1:8816 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3971
Practice Address - Country:US
Practice Address - Phone:980-704-6670
Practice Address - Fax:980-201-9605
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health