Provider Demographics
NPI:1407006323
Name:DORFNER, CONNIE FAY (PA-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:FAY
Last Name:DORFNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RIVER WALK MALL
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1026
Mailing Address - Country:US
Mailing Address - Phone:304-720-7317
Mailing Address - Fax:304-720-7319
Practice Address - Street 1:18 RIVER WALK MALL
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1026
Practice Address - Country:US
Practice Address - Phone:304-720-7317
Practice Address - Fax:304-720-7319
Is Sole Proprietor?:No
Enumeration Date:2008-09-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical