Provider Demographics
NPI:1518239144
Name:SIYANATA, DORCAS MARY (FNP)
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:MARY
Last Name:SIYANATA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1962
Mailing Address - Country:US
Mailing Address - Phone:937-293-2133
Mailing Address - Fax:
Practice Address - Street 1:3033 KETTERING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1948
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYARNP#3007219363LF0000X
OHCNP#12729-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily