Provider Demographics
NPI:1952446544
Name:GRESHAM, DOROTHY ANN (PHD, NP, CNOR)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:ANN
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:PHD, NP, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8698 YOUNG COURT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2253
Mailing Address - Country:US
Mailing Address - Phone:703-455-6058
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:WASHINGTON HOSPITAL CENTER OUTPATIENT BEHAVIOR HEALTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165154363L00000X
DCRN966304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner