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Individual
TINA M DORES
Active
Individual
TINA M DORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP122329
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430687077013
TRICARE
MO
05
—
919124701
—
MO
Enumeration date
08/01/2006
Last updated
12/03/2015
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