Healthcare Provider Details

I. General information

NPI: 1811795214
Provider Name (Legal Business Name): RYAN LEE DORSEY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 04/08/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SE COLUMBIA PALISADES DR
CAMAS WA
98607-8444
US

IV. Provider business mailing address

4500 SE COLUMBIA PALISADES DR
CAMAS WA
98607-8444
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61683004
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61064831
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: