Provider Demographics
NPI:1407019433
Name:DORR, CECELIA ANN (LPN LICENSED PRACTIC)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:ANN
Last Name:DORR
Suffix:
Gender:F
Credentials:LPN LICENSED PRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-452-8681
Mailing Address - Fax:
Practice Address - Street 1:134 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764
Practice Address - Country:US
Practice Address - Phone:740-342-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN036572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326423Medicare UPIN