Provider Demographics
NPI:1225350812
Name:DORMEUS, ROSE JUDITH
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:JUDITH
Last Name:DORMEUS
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 1:465 E 7TH ST
Mailing Address - Street 2:APT 3J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4849
Mailing Address - Country:US
Mailing Address - Phone:718-282-5394
Mailing Address - Fax:
Practice Address - Street 1:465 E 7TH ST
Practice Address - Street 2:APT 3J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4849
Practice Address - Country:US
Practice Address - Phone:718-282-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse