Healthcare Provider Details

I. General information

NPI: 1972872869
Provider Name (Legal Business Name): KIMBERLY R DOBRANSKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E BLOOMFIELD ST
ROME NY
13440-5300
US

IV. Provider business mailing address

620 E BLOOMFIELD ST
ROME NY
13440-5300
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-5319
  • Fax: 315-338-5306
Mailing address:
  • Phone: 315-338-5319
  • Fax: 315-338-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number606099-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: