Provider Demographics
NPI:1205355518
Name:VANACORE, DOREEN
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:VANACORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 STATE ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:SCIPIO CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147-3107
Mailing Address - Country:US
Mailing Address - Phone:315-730-2840
Mailing Address - Fax:
Practice Address - Street 1:2517 ST RTE 34
Practice Address - Street 2:
Practice Address - City:SCIPIO CENTER
Practice Address - State:NY
Practice Address - Zip Code:13147
Practice Address - Country:US
Practice Address - Phone:315-730-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319456-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse