Provider Demographics
NPI:1003353277
Name:DOSSO-DARCY, MATENE
Entity Type:Individual
Prefix:
First Name:MATENE
Middle Name:
Last Name:DOSSO-DARCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATENE
Other - Middle Name:
Other - Last Name:DOSSO-DARCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:11 MCKEEVER PL APT 6A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2553
Mailing Address - Country:US
Mailing Address - Phone:917-532-9482
Mailing Address - Fax:
Practice Address - Street 1:11 MCKEEVER PL APT 6A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2553
Practice Address - Country:US
Practice Address - Phone:917-532-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse