Provider Demographics
NPI:1578028528
Name:DORSEY, MARILYN SUSAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SUSAN
Last Name:DORSEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 MIAMI ST STE B
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2058
Mailing Address - Country:US
Mailing Address - Phone:419-447-0269
Mailing Address - Fax:
Practice Address - Street 1:668 MIAMI ST STE B
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2058
Practice Address - Country:US
Practice Address - Phone:419-447-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.P.R.N.C.N.P.023720363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner