MEDICARE: LAURA JAN 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	163W00000X	Registered Nurse	836856	TX

General Provider Information

NPI Number	:	1972093375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JAN DORSEY

Provider Business Mailing Address
First Line	:	922 CONCORD ST
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8519
Country	:	US
Telephone Number	:	972-971-8732
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 CONCORD ST
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8519
Country	:	US
Telephone Number	:	972-971-8732
Fax Number	:

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

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	05/11/2018

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Directions to “ LAURA JAN DORSEY ” Practice Location

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