Provider Demographics
NPI:1619622925
Name:DORE, JERMAINE
Entity Type:Individual
Prefix:MS
First Name:JERMAINE
Middle Name:
Last Name:DORE
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:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00831-1757
Mailing Address - Country:US
Mailing Address - Phone:340-514-9482
Mailing Address - Fax:
Practice Address - Street 1:3-2-3 ESTATE GRUNWALD
Practice Address - Street 2:
Practice Address - City:ST. JOHN
Practice Address - State:VI
Practice Address - Zip Code:00831
Practice Address - Country:US
Practice Address - Phone:340-514-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty