Provider Demographics
NPI:1720488000
Name:DORSEY, MEHATTIE (RN, CDOE)
Entity Type:Individual
Prefix:MRS
First Name:MEHATTIE
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:RN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2814
Mailing Address - Country:US
Mailing Address - Phone:401-714-1209
Mailing Address - Fax:
Practice Address - Street 1:239 CRANSTON ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2406
Practice Address - Country:US
Practice Address - Phone:401-444-0580
Practice Address - Fax:401-444-0428
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN37061163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator