Provider Demographics
NPI:1760612683
Name:DORCY, LIANE
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:
Last Name:DORCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIANE
Other - Middle Name:
Other - Last Name:DUPUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12758 E GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17761 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3925
Practice Address - Country:US
Practice Address - Phone:303-334-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009001988163W00000X, 363LF0000X
COAPN0990319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse