Provider Demographics
NPI:1063262061
Name:ADOVOR, DORIS WOETSA (BSN)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:WOETSA
Last Name:ADOVOR
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EVERGLADES LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7762
Mailing Address - Country:US
Mailing Address - Phone:703-597-8686
Mailing Address - Fax:540-318-8794
Practice Address - Street 1:49 EVERGLADES LN
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7762
Practice Address - Country:US
Practice Address - Phone:703-597-8686
Practice Address - Fax:540-318-8794
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001291308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse