Provider Demographics
NPI:1003252073
Name:VACA, DORIS YANETH
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:YANETH
Last Name:VACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:YANETH
Other - Last Name:OEFELEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-8802
Mailing Address - Country:US
Mailing Address - Phone:845-866-2511
Mailing Address - Fax:
Practice Address - Street 1:147 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-8802
Practice Address - Country:US
Practice Address - Phone:845-866-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649357-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical