Provider Demographics
NPI:1598030652
Name:WATHINGTON, DORINE (NP)
Entity Type:Individual
Prefix:
First Name:DORINE
Middle Name:
Last Name:WATHINGTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HUDSON CT
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-5515
Mailing Address - Country:US
Mailing Address - Phone:201-926-5358
Mailing Address - Fax:201-985-9323
Practice Address - Street 1:10 HUDSON CT
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-5515
Practice Address - Country:US
Practice Address - Phone:201-926-5358
Practice Address - Fax:201-985-9323
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337159363LF0000X
NJ26NJ00409800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily