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General NPI Number Information
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NPI Number | 1417422957
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Entity Type | Individual
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Provider Name | EBONI CHARMELE DORSEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 7125 MARVIN D LOVE FWY STE 107
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City | DALLAS
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State | TX
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Zip | 75237-3111
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Country | US
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Telephone | 972-332-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 DIAMONDBACK
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City | FORNEY
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State | TX
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Zip | 75126-5172
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Country | US
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Telephone | 409-673-1643
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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 | AP138332
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License Number State | TX
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