Provider Demographics
NPI:1043228943
Name:DEMORANVILLE, ALAN W (RN)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:W
Last Name:DEMORANVILLE
Suffix:
Gender:M
Credentials:RN
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Mailing Address - Street 1:118 GLEN ROAD S
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-735-9501
Practice Address - Fax:315-735-9769
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY4933721-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered