MEDICARE: MELINDA J DORSEY APN

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
1	163W00000X	Registered Nurse	275381	AZ
2	363LF0000X	Family Nurse Practitioner	275381	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	275381	OTHER	AZ	APRN

General Provider Information

NPI Number	:	1144850769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA J DORSEY APN

Provider Business Mailing Address
First Line	:	PO BOX 3428
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62708-3428
Country	:	US
Telephone Number	:	217-588-2624
Fax Number	:	217-757-2021

Provider Business Practice Location Address
First Line	:	9163 W UNION HILLS DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8186
Country	:	US
Telephone Number	:	623-250-2550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	05/09/2024

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