Provider Demographics
NPI:1093358947
Name:HIATT, DORI (LPN)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:HIATT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 MORGAN COUNTY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-3818
Mailing Address - Country:US
Mailing Address - Phone:423-346-5862
Mailing Address - Fax:423-717-5565
Practice Address - Street 1:3121 MORGAN COUNTY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3818
Practice Address - Country:US
Practice Address - Phone:423-346-5862
Practice Address - Fax:423-717-5565
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000052005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse