Provider Demographics
NPI:1881973139
Name:DORBER, POLLY (ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:POLLY
Middle Name:
Last Name:DORBER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W 15TH ST STE 425
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5848
Mailing Address - Country:US
Mailing Address - Phone:972-696-0030
Mailing Address - Fax:972-696-0037
Practice Address - Street 1:4001 W 15TH ST STE 425
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-696-0030
Practice Address - Fax:972-696-0037
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX766601163WR0006X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant