Provider Demographics
NPI:1124227665
Name:DORAN, MAUREEN RITA
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:RITA
Last Name:DORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:RITA
Other - Last Name:DORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5 BRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1004
Mailing Address - Country:US
Mailing Address - Phone:631-846-3347
Mailing Address - Fax:
Practice Address - Street 1:5 BRIAN AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1004
Practice Address - Country:US
Practice Address - Phone:631-846-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1518591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02755700Medicaid
NY1518591OtherLICENSE