MEDICARE: MS. BLANCHE DORSETT

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	177F00000X	Lodging Provider	112655	TX

General Provider Information

NPI Number	:	1578599692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BLANCHE DORSETT

Provider Business Mailing Address
First Line	:	9214 MCAFEE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1106
Country	:	US
Telephone Number	:	713-776-0560
Fax Number	:	713-772-3122

Provider Business Practice Location Address
First Line	:	9214 MCAFEE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1106
Country	:	US
Telephone Number	:	713-776-0560
Fax Number	:	713-772-3122

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/01/2008

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