Healthcare Provider Details

I. General information

NPI: 1164690723
Provider Name (Legal Business Name): DORASY B PAUL RN, LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N 4TH AVE
ANN ARBOR MI
48104-5503
US

IV. Provider business mailing address

110 N 4TH AVE
ANN ARBOR MI
48104-5503
US

V. Phone/Fax

Practice location:
  • Phone: 734-320-9717
  • Fax: 734-222-3731
Mailing address:
  • Phone: 734-320-9717
  • Fax: 734-222-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802082200
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704276621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: