Provider Demographics
NPI:1831960145
Name:DORTCH, SCHRONDA
Entity type:Individual
Prefix:
First Name:SCHRONDA
Middle Name:
Last Name:DORTCH
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 1:716 OTECA DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6630
Mailing Address - Country:US
Mailing Address - Phone:414-322-5223
Mailing Address - Fax:
Practice Address - Street 1:716 OTECA DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6630
Practice Address - Country:US
Practice Address - Phone:414-322-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion