Provider Demographics
NPI:1700263555
Name:DORSEY, CHARLENE PRUITT (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:PRUITT
Last Name:DORSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOUNT HOPE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-9013
Mailing Address - Country:US
Mailing Address - Phone:360-972-6819
Mailing Address - Fax:
Practice Address - Street 1:1748 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2441
Practice Address - Country:US
Practice Address - Phone:803-536-0613
Practice Address - Fax:260-877-2399
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100632163W00000X
SC19888363LF0000X
WAAP60733421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse