Provider Demographics
NPI:1285229658
Name:DORR, SIERRA ROSE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE
Last Name:DORR
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 1:109 TREMONT ST APT 410
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2433
Mailing Address - Country:US
Mailing Address - Phone:315-632-5020
Mailing Address - Fax:
Practice Address - Street 1:109 TREMONT ST APT 410
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2433
Practice Address - Country:US
Practice Address - Phone:315-632-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program