Healthcare Provider Details

I. General information

NPI: 1376173724
Provider Name (Legal Business Name): LORRIE EVANS DOVIN RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD BLDG D436
MOBILE AL
36608-6705
US

IV. Provider business mailing address

14575 DAUPHIN ISLAND PKWY
CODEN AL
36523-2909
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-2730
  • Fax: 251-266-2070
Mailing address:
  • Phone: 251-454-1151
  • Fax: 251-873-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1-051049
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: