Provider Demographics
NPI:1568037463
Name:DORSAINVIL, LYDIE
Entity Type:Individual
Prefix:
First Name:LYDIE
Middle Name:
Last Name:DORSAINVIL
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 1:2 W AYLESBURY RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4101
Mailing Address - Country:US
Mailing Address - Phone:410-561-9591
Mailing Address - Fax:
Practice Address - Street 1:2 W AYLESBURY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4101
Practice Address - Country:US
Practice Address - Phone:410-561-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP50002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse