Provider Demographics
NPI:1558143479
Name:CAVALIERE, DOROTHY JILL
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JILL
Last Name:CAVALIERE
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 1:121 W PORTAL RD
Mailing Address - Street 2:
Mailing Address - City:PORTAL
Mailing Address - State:AZ
Mailing Address - Zip Code:85632-8006
Mailing Address - Country:US
Mailing Address - Phone:575-644-2045
Mailing Address - Fax:
Practice Address - Street 1:401 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045-1614
Practice Address - Country:US
Practice Address - Phone:575-542-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM409955163WS0200X
NMR51594163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool