Provider Demographics
NPI:1760660278
Name:DOURTE, ADRIANE
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:
Last Name:DOURTE
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 1:541 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4014
Mailing Address - Country:US
Mailing Address - Phone:484-319-7700
Mailing Address - Fax:
Practice Address - Street 1:809 N STATE ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2163
Practice Address - Country:US
Practice Address - Phone:717-738-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000035171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist