Basic Information
| Provider Information | |||||||||
| NPI: | 1659321172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLAYTER | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | JOAN | ||||||||
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| Credential: | RN BSN RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2632 WINTERS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095753545 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2632 WINTERS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095718330 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/10/2008 | ||||||||
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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 | 163W00000X | 161994 | CA | N | Nursing Service Providers | Registered Nurse | 208600000X | 161994 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 161994 | 01 | CA | STATE LICENSE NUMBER | OTHER |