Provider Demographics
NPI:1558933614
Name:DEGENNARO, DOREEN LINDA
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:LINDA
Last Name:DEGENNARO
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-0148
Mailing Address - Country:US
Mailing Address - Phone:518-449-1142
Mailing Address - Fax:518-449-1320
Practice Address - Street 1:87 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2613
Practice Address - Country:US
Practice Address - Phone:518-449-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY537423-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health