Provider Demographics
NPI:1255883229
Name:FERNANDEZ, DOROTHY EMILY (RN, BSN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:EMILY
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5459 N 77TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-5674
Mailing Address - Country:US
Mailing Address - Phone:602-434-2830
Mailing Address - Fax:
Practice Address - Street 1:2252 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3706
Practice Address - Country:US
Practice Address - Phone:623-691-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN199079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse