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General NPI Number Information
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NPI Number | 1376105171
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Entity Type | Individual
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Provider Name | JENNIFER DORN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 1298 W FINNIE FLAT RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-5958
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Country | US
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Telephone | 928-639-5555
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Fax | 928-639-5554
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Provider Business Mailing Address
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Address Line | 5317 S TATUM LN
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City | GILBERT
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State | AZ
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Zip | 85298-0356
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Country | US
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Telephone | 480-754-9286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 225007
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License Number State | AZ
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