Provider Demographics
NPI:1346218039
Name:DORSEY, ELIZABETH J (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:DORSEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 REDWOOD TREE ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6919
Mailing Address - Country:US
Mailing Address - Phone:435-674-2482
Mailing Address - Fax:435-674-2482
Practice Address - Street 1:754 N MAIN
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ132166367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ942989Medicaid
AZ942989-03Medicaid
UTP00630859OtherRAILROAD MEDICARE PART B
UT000064140Medicare PIN
UTP00630859Medicare PIN
UTP00630859OtherRAILROAD MEDICARE PART B
S48711Medicare UPIN
AZ110057Medicare ID - Type UnspecifiedMAYO CLINIC ARIZONA