Provider Demographics
NPI:1922097906
Name:DOVE, DORINDA FAYE (CNM)
Entity Type:Individual
Prefix:MS
First Name:DORINDA
Middle Name:FAYE
Last Name:DOVE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4047
Mailing Address - Country:US
Mailing Address - Phone:302-475-6017
Mailing Address - Fax:
Practice Address - Street 1:1508 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3110
Practice Address - Country:US
Practice Address - Phone:302-658-2229
Practice Address - Fax:302-658-2382
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK-0000105367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000915839Medicaid
DE0000915839Medicaid