Provider Demographics
NPI:1659143709
Name:DORTCH, RHONDA L
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:DORTCH
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 1:420 BRADSHAW RUN
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:WV
Mailing Address - Zip Code:24935
Mailing Address - Country:US
Mailing Address - Phone:304-466-9288
Mailing Address - Fax:
Practice Address - Street 1:420 BRADSHAW RUN
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:WV
Practice Address - Zip Code:24935
Practice Address - Country:US
Practice Address - Phone:304-466-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant