Provider Demographics
NPI:1801132402
Name:SILLS, DORIS MARIE
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:MARIE
Last Name:SILLS
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 1:314 VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2342
Mailing Address - Country:US
Mailing Address - Phone:937-396-0728
Mailing Address - Fax:
Practice Address - Street 1:314 VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2342
Practice Address - Country:US
Practice Address - Phone:937-396-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-185743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse