Provider Demographics
NPI:1568886828
Name:DORSEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DORSEY
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 1:1760 S SALEM RD
Mailing Address - Street 2:APT. 10
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8549
Mailing Address - Country:US
Mailing Address - Phone:501-336-0323
Mailing Address - Fax:
Practice Address - Street 1:1100 BOB COURTWAY DR
Practice Address - Street 2:SUITE 9
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4766
Practice Address - Country:US
Practice Address - Phone:501-328-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator