Healthcare Provider Details

I. General information

NPI: 1851264642
Provider Name (Legal Business Name): KRISTINA MAY DORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NEOTOMAS AVE
SANTA ROSA CA
95405-7537
US

IV. Provider business mailing address

938 BOYD ST
SANTA ROSA CA
95407-6101
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4700
  • Fax:
Mailing address:
  • Phone: 707-565-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95386944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: