Provider Demographics
NPI:1336809037
Name:DORSEY, WENDY M
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:DORSEY
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 1:15523 WOODWORTH
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3968
Mailing Address - Country:US
Mailing Address - Phone:405-693-6059
Mailing Address - Fax:888-875-1829
Practice Address - Street 1:5350 S WESTERN AVE STE 524
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4536
Practice Address - Country:US
Practice Address - Phone:405-731-9012
Practice Address - Fax:888-875-1829
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty