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NPI Code Detail

MEDICARE: DORETHA DORDAIN

MEDICARE: DORETHA DORDAIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041278763IL

General Provider Information

NPI Number : 1255268041
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORETHA DORDAIN
Provider Business Mailing Address
First Line : 820 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3728
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 820 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3728
Country : US
Telephone Number : 312-569-6246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2026
Last Update Date : 05/06/2026

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Directions to “ DORETHA DORDAIN ” Practice Location

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