Provider Demographics
NPI:1205412079
Name:DORSEY-HATCHETT, NICOLE ANN
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:DORSEY-HATCHETT
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 1:3322 193RD ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3860
Mailing Address - Country:US
Mailing Address - Phone:773-350-9896
Mailing Address - Fax:
Practice Address - Street 1:3322 193RD ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3860
Practice Address - Country:US
Practice Address - Phone:773-350-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management