Provider Demographics
NPI:1164185443
Name:DORSEY, DESIRAE RAQUEL (ARNP)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:RAQUEL
Last Name:DORSEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8005
Mailing Address - Country:US
Mailing Address - Phone:509-300-8028
Mailing Address - Fax:
Practice Address - Street 1:202 LENORE LANE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98841-9759
Practice Address - Country:US
Practice Address - Phone:509-300-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61222170363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61222170OtherNURSE PRACTITIONER-FAMILY, MSN, ARNP, FNP-C