Healthcare Provider Details

I. General information

NPI: 1548826464
Provider Name (Legal Business Name): KATHRYN DORE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WILLOWOOD DR
EWING NJ
08628-1916
US

IV. Provider business mailing address

4 WILLOWOOD DR
EWING NJ
08628-1916
US

V. Phone/Fax

Practice location:
  • Phone: 609-477-9439
  • Fax:
Mailing address:
  • Phone: 609-477-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00920400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: