Provider Demographics
NPI:1164095741
Name:DENSON, DOROTHEA MICHELLE
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:MICHELLE
Last Name:DENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PERKINS LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7456
Mailing Address - Country:US
Mailing Address - Phone:386-235-0661
Mailing Address - Fax:
Practice Address - Street 1:25 PERKINS LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7456
Practice Address - Country:US
Practice Address - Phone:386-235-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health