Provider Demographics
NPI:1730470857
Name:DORZOK, WANDA ANN (RN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ANN
Last Name:DORZOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10407 BITTERSWEET RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-8497
Mailing Address - Country:US
Mailing Address - Phone:715-355-2148
Mailing Address - Fax:
Practice Address - Street 1:10407 BITTERSWEET RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-8497
Practice Address - Country:US
Practice Address - Phone:715-355-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse