Provider Demographics
NPI:1043314271
Name:DUTTON, DOROTHY JOY (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JOY
Last Name:DUTTON
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:94125 4TH STREET
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-1215
Mailing Address - Country:US
Mailing Address - Phone:541-247-6628
Mailing Address - Fax:541-247-6629
Practice Address - Street 1:94125 4TH STREET
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:541-247-6628
Practice Address - Fax:541-247-6629
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650112NP FNP-PP363LF0000X
OR200150025NP NMNP-PP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00420229OtherRAILROAD MEDICARE
OR278504Medicaid
OR891095002OtherREGENCE BLUECROSS
ORP00420229OtherRAILROAD MEDICARE
OR278504Medicaid