Provider Demographics
NPI:1679224182
Name:PRINCEWILL, DOROTHY (RN, MSN, MBA)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:PRINCEWILL
Suffix:
Gender:F
Credentials:RN, MSN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 BRILLIANT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1571
Mailing Address - Country:US
Mailing Address - Phone:708-275-3431
Mailing Address - Fax:
Practice Address - Street 1:8484 WILL CLAYTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5830
Practice Address - Country:US
Practice Address - Phone:708-275-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX860820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse