Provider Demographics
NPI:1619775616
Name:DORRIS, TERRENCE JR (PCA)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:DORRIS
Suffix:JR
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 S 163RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4308
Mailing Address - Country:US
Mailing Address - Phone:402-955-9534
Mailing Address - Fax:
Practice Address - Street 1:6818 GROVER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3640
Practice Address - Country:US
Practice Address - Phone:402-390-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide