Provider Demographics
NPI:1992751416
Name:DORAN, MICHELLE DYMENT (APRN, BC-PCM)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DYMENT
Last Name:DORAN
Suffix:
Gender:F
Credentials:APRN, BC-PCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SALEM ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0039
Mailing Address - Country:US
Mailing Address - Phone:781-587-1403
Mailing Address - Fax:
Practice Address - Street 1:331 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5420
Practice Address - Country:US
Practice Address - Phone:978-594-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217472363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology