GARRY ROGER DORMEVIL NURSE PRACTITIONER NPI 1164196457

NPI Information

NPI: 1164196457
Provider Name: GARRY ROGER DORMEVIL, NURSE PRACTITIONER
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
79440 CORPORATE CENTER DR STE 100
LA QUINTA, CA
ZIP 92253
Phone: (805) 719-3700
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Garry Roger Dormevil, NURSE PRACTITIONER is a family nurse practitioner in La Quinta, CA. Garry Roger Dormevil, NURSE PRACTITIONER NPI is 1164196457. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

79440 CORPORATE CENTER DR STE 100
LA QUINTA, CA
ZIP 92253-243
Phone: (805) 719-3700
Fax: (805) 413-9099

The NPI 1164196457 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/2/2021 and was last updated on 4/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	0024180743	VIRGINIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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