1164185443 NPI number — DESIRAE RAQUEL DORSEY PMH-NP, ARNP, FNP

Table of content: DESIRAE RAQUEL DORSEY PMH-NP, ARNP, FNP (NPI 1164185443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164185443 NPI number — DESIRAE RAQUEL DORSEY PMH-NP, ARNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORSEY
Provider First Name:
DESIRAE
Provider Middle Name:
RAQUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMH-NP, ARNP, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164185443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 HIGHWAY 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98816-8005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-300-8028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 LENORE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841-9759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-300-8028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP61222170 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: AP61222170 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AP61222170 . This is a "NURSE PRACTITIONER-FAMILY, MSN, ARNP, FNP-C" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2024028064 . This is a "ANCC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2024028064 . This is a "PMH-NP CERTIFICATION -BC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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