Provider Demographics
NPI:1518909662
Name:MAIN-DORSKY, KATRINA MCMANUS (NP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MCMANUS
Last Name:MAIN-DORSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:FAMILY PLANNING ASSOCIATION OF MAINE
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0587
Mailing Address - Country:US
Mailing Address - Phone:207-622-7524
Mailing Address - Fax:
Practice Address - Street 1:34 GABRIEL DRIVE
Practice Address - Street 2:FAMILY PLANNING ASSOCIATION OF MAINE
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04332
Practice Address - Country:US
Practice Address - Phone:207-622-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER039125363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME261110099Medicaid