Provider Demographics
NPI:1043261985
Name:RODRIGUEZ, DOROTHY HELEN (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:HELEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:DOTTIE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:3145 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1602
Mailing Address - Country:US
Mailing Address - Phone:248-338-5000
Mailing Address - Fax:248-338-5584
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2217
Practice Address - Country:US
Practice Address - Phone:248-338-5210
Practice Address - Fax:248-338-5584
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167051363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care