Provider Demographics
NPI:1184830051
Name:DORAN, CHRISTINE ANN (RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:DORAN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-3358
Mailing Address - Country:US
Mailing Address - Phone:716-629-8451
Mailing Address - Fax:
Practice Address - Street 1:161 CLINTON ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-3358
Practice Address - Country:US
Practice Address - Phone:716-629-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002983133N00000X
ILR604590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000585058001OtherBLUE CROSS & BLUE SHIELD
NY6511412OtherINDEPENDENT HEALTH
NYDD4724Medicare ID - Type Unspecified