Provider Demographics
NPI:1598986481
Name:DORN, NANCY ELLEN (RN, ARNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELLEN
Last Name:DORN
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 MINOR AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1448
Practice Address - Country:US
Practice Address - Phone:206-442-5230
Practice Address - Fax:206-287-4677
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003460363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9612946Medicaid
WA9612946Medicaid