Provider Demographics
NPI:1447233440
Name:KENT, DOROTHY C (MSN,PNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:C
Last Name:KENT
Suffix:
Gender:F
Credentials:MSN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1578
Mailing Address - Country:US
Mailing Address - Phone:847-688-2255
Mailing Address - Fax:847-688-7475
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:NAVAL HOSPITAL,
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-2255
Practice Address - Fax:847-688-7475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003420(41-221417363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics