Provider Demographics
NPI:1033301999
Name:VARRICHIO PRINE, DOREEN M (RN)
Entity Type:Individual
Prefix:MISS
First Name:DOREEN
Middle Name:M
Last Name:VARRICHIO PRINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 KETCHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2029
Mailing Address - Country:US
Mailing Address - Phone:516-938-3132
Mailing Address - Fax:
Practice Address - Street 1:32 KETCHAM AVENUE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2029
Practice Address - Country:US
Practice Address - Phone:516-938-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2794171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02512389Medicaid