1588387401 NPI number — MR. STEPHEN EVERETT DORSEY IV RN

Table of content: MR. STEPHEN EVERETT DORSEY IV RN (NPI 1588387401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588387401 NPI number — MR. STEPHEN EVERETT DORSEY IV RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORSEY
Provider First Name:
STEPHEN
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
RN
Provider Gender Code:
M

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:
1588387401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 BALLPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-712-3784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 CAPITOL STREET
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-6262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-512-8549
Provider Business Practice Location Address Fax Number:
207-512-8552
Provider Enumeration Date:
09/26/2022

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: 163W00000X , with the licence number:  RN57480 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com