MEDICARE: MRS. DOROTHY RENEE IDRIS RN

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	172A00000X	Driver	RT187022	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	RN284383	OH
3	163WC0400X	Case Management Registered Nurse	RN284383	OH
4	163WC2100X	Continence Care Registered Nurse	RN284383	OH
5	163WD1100X	Peritoneal Dialysis Registered Nurse	RN284383	OH
6	163WE0900X	Enterostomal Therapy Registered Nurse	RN284383	OH
7	163WG0000X	General Practice Registered Nurse	RN284383	OH
8	163WG0100X	Gastroenterology Registered Nurse	RN284383	OH
9	163WG0600X	Gerontology Registered Nurse	RN284383	OH
10	163WH0200X	Home Health Registered Nurse	RN284383	OH
11	163WH1000X	Hospice Registered Nurse	RN284383	OH
12	163WP0000X	Pain Management Registered Nurse	RN284383	OH
13	163WP2201X	Ambulatory Care Registered Nurse	RN284383	OH
14	163WW0000X	Wound Care Registered Nurse	RN284383	OH
15	163WX1500X	Ostomy Care Registered Nurse	RN284383	OH

General Provider Information

NPI Number	:	1689920936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY RENEE IDRIS RN

Provider Business Mailing Address
First Line	:	3285 RENFRO AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6624
Country	:	US
Telephone Number	:	513-546-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3285 RENFRO AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6624
Country	:	US
Telephone Number	:	513-546-8002
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	08/20/2013

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