Basic Information
| Provider Information | |||||||||
| NPI: | 1720488000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORSEY | ||||||||
| FirstName: | MEHATTIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CDOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029052814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017141209 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 239 CRANSTON ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029072406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014440580 | ||||||||
| FaxNumber: | 4014440428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2014 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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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 | 163WD0400X | RN37061 | MD | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.