Individual
ANGELA MARIE DORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
24-QMHA-I-004240
OR
175T00000X
Peer Specialist
THW000106401
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500803898
—
OR
05
—
500804950
—
OR
01
—
ZH457070F
DRIVERS LICENSE
ID
Enumeration date
02/24/2022
Last updated
04/08/2024
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