Provider Demographics
NPI:1629036967
Name:DORSEY, BETTY JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JEAN
Last Name:DORSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:JEAN
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:105 LANGFORD LK
Mailing Address - Street 2:ROOM 206
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1410
Mailing Address - Country:US
Mailing Address - Phone:760-380-3818
Mailing Address - Fax:
Practice Address - Street 1:2237 CONQUEST WAY
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2679
Practice Address - Country:US
Practice Address - Phone:410-674-6734
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113465163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG0384OtherWORKERS COMPANSATION CASE