Healthcare Provider Details

I. General information

NPI: 1750801940
Provider Name (Legal Business Name): NANCY LEE DORMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 STIRLING DR
INTERLOCHEN MI
49643-9264
US

IV. Provider business mailing address

6227 FRANKFORT HWY
BENZONIA MI
49616-8632
US

V. Phone/Fax

Practice location:
  • Phone: 231-275-7965
  • Fax:
Mailing address:
  • Phone: 231-882-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704246796
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: