Healthcare Provider Details

I. General information

NPI: 1801173174
Provider Name (Legal Business Name): CHERYL CONNOR DOREMUS RN/BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WARD SQ
LITTLE FALLS NY
13365-1606
US

IV. Provider business mailing address

1 WARD SQ
LITTLE FALLS NY
13365-1606
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-2280
  • Fax: 315-823-3652
Mailing address:
  • Phone: 315-823-2280
  • Fax: 315-823-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number358441-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: