MEDICARE: MS. DEBRA DORSEY

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	164X00000X	Licensed Vocational Nurse	127835	TX

General Provider Information

NPI Number	:	1417137670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA DORSEY

Provider Business Mailing Address
First Line	:	5923 LAKEDALE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-1713
Country	:	US
Telephone Number	:	210-445-1917
Fax Number	:

Provider Business Practice Location Address
First Line	:	5923 LAKEDALE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-1713
Country	:	US
Telephone Number	:	210-445-1917
Fax Number	:

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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