Provider Demographics
NPI:1356596118
Name:MCGOVERN, DORA (RN)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-2097
Mailing Address - Country:US
Mailing Address - Phone:760-455-8729
Mailing Address - Fax:
Practice Address - Street 1:2251 S OTONDO DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8843
Practice Address - Country:US
Practice Address - Phone:928-344-8150
Practice Address - Fax:928-344-8168
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTRN155250163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool