Provider Demographics
NPI:1073119285
Name:DORSEY, MILLIE K (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:K
Last Name:DORSEY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 S JORDAN VALLEY WAY STE 2A
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9772
Mailing Address - Country:US
Mailing Address - Phone:801-935-8180
Mailing Address - Fax:801-930-9073
Practice Address - Street 1:8785 S JORDAN VALLEY WAY STE 2A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9772
Practice Address - Country:US
Practice Address - Phone:801-935-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8615809-4405363L00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner