Provider Demographics
NPI:1619226636
Name:DODDS, KRISTEN M
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:M
Last Name:DODDS
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 1:83 CRIMSON BRAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4225
Mailing Address - Country:US
Mailing Address - Phone:585-775-9603
Mailing Address - Fax:
Practice Address - Street 1:83 CRIMSON BRAMBLE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4225
Practice Address - Country:US
Practice Address - Phone:585-775-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280432164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse