Dortenzo, Mary Regina

Dortenzo, Mary Regina is an individual health care provider with primary practice located at 216 Edgefield Ave Nw , Aiken SC 29801-3910. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Dortenzo, Mary Regina can be contacted via phone (803) 648-4224.

Contact Information

Primary practice address
216 Edgefield Ave Nw Aiken SC 29801-3910
Phone: (803) 648-4224
Fax: (803) 641-7600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 4097 South Carolina

Profile Details

NPI number 1215105085
LBN Legal business name Dortenzo, Mary Regina
Credentials RN-ANP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2008
Last updated Jun 30th, 2016 - 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 1215105085 NPPES
South Carolina MEDICAID NP1564

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