Provider Demographics
NPI:1396151189
Name:CHRISTINA ANGELA DORRIS
Entity type:Organization
Organization Name:CHRISTINA ANGELA DORRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:309-660-6401
Mailing Address - Street 1:103 N ORR DR
Mailing Address - Street 2:APT 6
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1965
Mailing Address - Country:US
Mailing Address - Phone:309-660-6401
Mailing Address - Fax:309-451-0897
Practice Address - Street 1:103 N ORR DR
Practice Address - Street 2:APT 6
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1965
Practice Address - Country:US
Practice Address - Phone:309-660-6401
Practice Address - Fax:309-451-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041330854163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty