Provider Demographics
NPI:1518546720
Name:DORSEY, DONNELL
Entity Type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:DORSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 MONTESSOURI ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3059
Mailing Address - Country:US
Mailing Address - Phone:702-207-2526
Mailing Address - Fax:702-447-2524
Practice Address - Street 1:2575 MONTESSOURI ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3059
Practice Address - Country:US
Practice Address - Phone:702-207-2526
Practice Address - Fax:702-447-2524
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant