Healthcare Provider Details

I. General information

NPI: 1790107407
Provider Name (Legal Business Name): TINA MARIE DORNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MYERS DORNER

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 415 BOX 3436
APO AE
09114-0035
US

IV. Provider business mailing address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09114
US

V. Phone/Fax

Practice location:
  • Phone: 499641836584
  • Fax:
Mailing address:
  • Phone: 499662834719
  • Fax: 499662834721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN150467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: