Provider Demographics
NPI:1922981810
Name:DORSEY, JANE CAROL
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CAROL
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 W BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3508
Mailing Address - Country:US
Mailing Address - Phone:208-284-2165
Mailing Address - Fax:208-284-2165
Practice Address - Street 1:1370 W BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3508
Practice Address - Country:US
Practice Address - Phone:208-284-2165
Practice Address - Fax:208-284-2165
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist