Provider Demographics
NPI:1598008757
Name:CALDWELL, DORIS JEAN (RN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 W LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7684
Mailing Address - Country:US
Mailing Address - Phone:602-363-9870
Mailing Address - Fax:
Practice Address - Street 1:350 S 118TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1177
Practice Address - Country:US
Practice Address - Phone:623-478-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ866000508390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program