MEDICARE: MRS. PATRICIA DORMER 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
1	363LF0000X	Family Nurse Practitioner	14053	CT
2	363LF0000X	Family Nurse Practitioner	351594	NY

General Provider Information

NPI Number	:	1619795796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA DORMER FNP

Provider Business Mailing Address
First Line	:	944 E 226TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 SUMMER ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-4311
Country	:	US
Telephone Number	:	203-969-2000
Fax Number	:

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

Provider Enumeration Date	:	09/28/2024
Last Update Date	:	11/13/2024

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