Provider Demographics
NPI:1386367381
Name:DODD, MARY TERESE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESE
Last Name:DODD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7306
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-7306
Mailing Address - Country:US
Mailing Address - Phone:707-683-5073
Mailing Address - Fax:
Practice Address - Street 1:874 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-1926
Practice Address - Country:US
Practice Address - Phone:707-725-3334
Practice Address - Fax:707-725-2455
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily