MEDICARE: DORI HEALEY LLC

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	364SA2200X	Adult Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1770279606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORI HEALEY LLC

Provider Business Mailing Address
First Line	:	12404 W VIEW RIDGE DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-0009
Country	:	US
Telephone Number	:	208-550-3112
Fax Number	:

Provider Business Practice Location Address
First Line	:	12404 W VIEW RIDGE DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-0009
Country	:	US
Telephone Number	:	208-550-3112
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HEATHER BEARD
Credential	:
Telephone Number	:	208-550-3112

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	01/16/2025

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