Provider Demographics
NPI:1316227226
Name:PRATT, DORA G (RN)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:G
Last Name:PRATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0342
Mailing Address - Country:US
Mailing Address - Phone:740-395-3114
Mailing Address - Fax:740-596-2632
Practice Address - Street 1:405 CHILLICOTHE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1207
Practice Address - Country:US
Practice Address - Phone:740-395-3114
Practice Address - Fax:740-596-2632
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 283599163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice