Provider Demographics
NPI:1326007881
Name:DODDATO, THERESA (RN, PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:DODDATO
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WATERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6527
Mailing Address - Country:US
Mailing Address - Phone:601-919-1631
Mailing Address - Fax:
Practice Address - Street 1:1207 N WEST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2018
Practice Address - Country:US
Practice Address - Phone:601-354-6654
Practice Address - Fax:601-354-6289
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR856512163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care