Basic Information
| Provider Information | |||||||||
| NPI: | 1508028705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORCE | ||||||||
| FirstName: | HANNA | ||||||||
| MiddleName: | NICOLE THOMPSON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMPSON | ||||||||
| OtherFirstName: | HANNA | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1061 HARMON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124355965 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1061 HARMON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124355965 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2008 | ||||||||
| LastUpdateDate: | 08/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.