Provider Demographics
NPI:1043856339
Name:PRICE, DOREAN (RN, ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:DOREAN
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:RN, ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BEATTY LN
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7600
Mailing Address - Country:US
Mailing Address - Phone:803-226-0099
Mailing Address - Fax:803-226-0229
Practice Address - Street 1:119 BEATTY LN
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7600
Practice Address - Country:US
Practice Address - Phone:803-226-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1380Medicaid