Provider Demographics
NPI:1982210779
Name:DOERMAN, RAPHAELA MANUEL (RN)
Entity Type:Individual
Prefix:
First Name:RAPHAELA
Middle Name:MANUEL
Last Name:DOERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RAPHAELA
Other - Middle Name:FUENTES
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1211 21ST AVENUE SOUTH
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE 514
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-5280
Mailing Address - Country:US
Mailing Address - Phone:615-481-8306
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVENUE SOUTH
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 514
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-5280
Practice Address - Country:US
Practice Address - Phone:615-481-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN211731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse