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NPI Code Detail

MEDICARE: MS. KATHLEEN ROSE DOURIS APRN, MSN

MEDICARE: MS. KATHLEEN ROSE DOURIS APRN, MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerF301051-1NY
2363LG0600XGerontology Nurse PractitionerF340061-1NY

General Provider Information

NPI Number : 1053363275
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN ROSE DOURIS APRN, MSN
Provider Business Mailing Address
First Line : 9322 THIRD AVENUE
Second Line : SUITE 316
City : BROOKLYN
State : NY
Zip : 11209-1208
Country : US
Telephone Number : 718-630-3730
Fax Number : 718-630-2970
Provider Business Practice Location Address
First Line : 800 POLY PL # 11H
Second Line : NEW YORK HARBOR VA HEALTH CARE SYSTEM
City : BROOKLYN
State : NY
Zip : 11209-7104
Country : US
Telephone Number : 718-630-3730
Fax Number : 718-630-2970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/06/2011

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