Basic Information
| Provider Information | |||||||||
| NPI: | 1346218039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORSEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1179 REDWOOD TREE ST | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847906919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356742482 | ||||||||
| FaxNumber: | 4356742482 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 N MAIN | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356282671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 11/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 132166 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 942989 | 05 | AZ | MEDICAID | 942989-03 | 05 | AZ | MEDICAID | P00630859 | 01 | UT | RAILROAD MEDICARE PART B | OTHER |