Provider Demographics
NPI:1477708584
Name:DODGE, MAUREEN PATRICIA (RN)
Entity Type:Individual
Prefix:MISS
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:DODGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 INGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5307
Mailing Address - Country:US
Mailing Address - Phone:347-551-9849
Mailing Address - Fax:
Practice Address - Street 1:2627 INGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5307
Practice Address - Country:US
Practice Address - Phone:347-551-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY562072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse