Provider Demographics
NPI:1700305661
Name:DORR, RENEE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DORR
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 ORCHARD HWY
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9754
Mailing Address - Country:US
Mailing Address - Phone:231-398-2258
Mailing Address - Fax:231-398-3330
Practice Address - Street 1:2840 ORCHARD HWY
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9754
Practice Address - Country:US
Practice Address - Phone:231-398-2258
Practice Address - Fax:231-398-3330
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily