MEDICARE: MRS. DORANNE CLEARY R.N.

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
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	359479-1	NY

General Provider Information

NPI Number	:	1134438989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORANNE CLEARY R.N.

Provider Business Mailing Address
First Line	:	532 NEPTUNE AVE
Second Line	:	200
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4010
Country	:	US
Telephone Number	:	718-946-2600
Fax Number	:	718-265-0430

Provider Business Practice Location Address
First Line	:	532 NEPTUNE AVE
Second Line	:	200
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4010
Country	:	US
Telephone Number	:	718-946-2600
Fax Number	:	718-265-0430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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