Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024170681 | VA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | SP 011735 | PA |
NPI | 1003186701 |
---|---|
Provider Name | Ms. Candyce S Dorsey |
First Address | Zion Crossroads, VA 22942-6952 |
Second Address | Philadelphia, PA 19146-4808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 28/02/2013 |