Shackleford, Dorothy Lorraine

Shackleford, Dorothy Lorraine is an individual health care provider with primary practice located at 3963 Hartlake St , Woodbridge VA 22192-7477. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Shackleford, Dorothy Lorraine can be contacted via phone (703) 590-2019.

Contact Information

Primary practice address
3963 Hartlake St Woodbridge VA 22192-7477
Phone: (703) 590-2019
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 598148 California
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0001212718 Virginia

Profile Details

NPI number 1003888447
LBN Legal business name Shackleford, Dorothy Lorraine
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Apr 23rd, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003888447 NPPES
Virginia MEDICAID 1003888447
Virginia Other P01179302

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