Provider Demographics
NPI:1316026305
Name:STEVENS, DOROTHY CORRAL (NP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:CORRAL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:HILTON
Other - Last Name:CORRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11 WOODLAND PARK RD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2314
Mailing Address - Country:US
Mailing Address - Phone:631-286-9278
Mailing Address - Fax:
Practice Address - Street 1:225 RABRO DRIVE EAST
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4290
Practice Address - Country:US
Practice Address - Phone:631-853-3020
Practice Address - Fax:631-853-3051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317809163W00000X
NYF420505363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health