Healthcare Provider Details

I. General information

NPI: 1124122122
Provider Name (Legal Business Name): DOROTHY L. DUERFELDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 NORTH GREEN ST
VALENTINE NE
69201-1982
US

IV. Provider business mailing address

PO BOX 410
VALENTINE NE
69201-0410
US

V. Phone/Fax

Practice location:
  • Phone: 402-376-3770
  • Fax: 402-376-3779
Mailing address:
  • Phone: 402-376-2525
  • Fax: 402-376-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1172
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: