Provider Demographics
NPI:1659321172
Name:SLAYTER, DOROTHY JOAN (RN BSN RNFA)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JOAN
Last Name:SLAYTER
Suffix:
Gender:F
Credentials:RN BSN RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 WINTERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-575-3545
Mailing Address - Fax:
Practice Address - Street 1:2632 WINTERS DRIVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-571-8330
Practice Address - Fax:209-491-7184
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161994163W00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161994OtherSTATE LICENSE NUMBER