Provider Demographics
NPI:1306681234
Name:DORKO, CAROLINE (PNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DORKO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ASPINWALL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6442
Mailing Address - Country:US
Mailing Address - Phone:571-408-3892
Mailing Address - Fax:
Practice Address - Street 1:25 ASPINWALL AVE APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6442
Practice Address - Country:US
Practice Address - Phone:571-408-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2333735163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse