Healthcare Provider Details

I. General information

NPI: 1679876114
Provider Name (Legal Business Name): NATHASIA DORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20970 LYNWOOD RD
WAYNESVILLE MO
65583-4601
US

IV. Provider business mailing address

126 MISSOURI AVE
FORT LEONARD WOOD MO
65473-8952
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number055375
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: