Provider Demographics
NPI:1508104225
Name:FAULKNER, DOROTHY ELLEN
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELLEN
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20135 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5320
Mailing Address - Country:US
Mailing Address - Phone:734-225-1006
Mailing Address - Fax:734-225-1027
Practice Address - Street 1:20135 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5320
Practice Address - Country:US
Practice Address - Phone:734-225-1006
Practice Address - Fax:734-225-1027
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider