Provider Demographics
NPI:1164690723
Name:PAUL, DORASY B (RN, LLMSW)
Entity Type:Individual
Prefix:MS
First Name:DORASY
Middle Name:B
Last Name:PAUL
Suffix:
Gender:F
Credentials:RN, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5503
Mailing Address - Country:US
Mailing Address - Phone:734-320-9717
Mailing Address - Fax:734-222-3731
Practice Address - Street 1:110 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5503
Practice Address - Country:US
Practice Address - Phone:734-320-9717
Practice Address - Fax:734-222-3731
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020822001041C0700X
MI4704276621163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYP918050516OtherBLUE CROSS BLUE SHIELD OF MICHIGAN