Healthcare Provider Details

I. General information

NPI: 1033744891
Provider Name (Legal Business Name): SUZANNE DOZORETZ NP, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DR
ITHACA NY
14850-1342
US

IV. Provider business mailing address

308 LAKE AVE
ITHACA NY
14850-3510
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4011
  • Fax:
Mailing address:
  • Phone: 607-220-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number671508-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345950-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: