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NPI Code Detail

MEDICARE: SUSAN MARIE DORMAN RN, CS-FNP

MEDICARE: SUSAN MARIE DORMAN RN, CS-FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner107376CO

General Provider Information

NPI Number : 1033317557
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MARIE DORMAN RN, CS-FNP
Provider Business Mailing Address
First Line : PO BOX 334
Second Line :
City : BURLINGTON
State : CO
Zip : 80807-0334
Country : US
Telephone Number : 719-346-5301
Fax Number : 719-346-5042
Provider Business Practice Location Address
First Line : 451 14TH ST
Second Line :
City : BURLINGTON
State : CO
Zip : 80807-1609
Country : US
Telephone Number : 719-346-4681
Fax Number : 719-346-8742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2007
Last Update Date : 09/19/2022

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