Provider Demographics
NPI:1053004887
Name:BASSEY, DOROTHY B
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:B
Last Name:BASSEY
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 1:18400 CHERRY CREEK DR APT 312
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2934
Mailing Address - Country:US
Mailing Address - Phone:312-647-8563
Mailing Address - Fax:
Practice Address - Street 1:18400 CHERRY CREEK DR APT 312
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2934
Practice Address - Country:US
Practice Address - Phone:312-647-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027521363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health