Provider Demographics
NPI:1689920936
Name:IDRIS, DOROTHY RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:RENEE
Last Name:IDRIS
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 1:3285 RENFRO AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6624
Mailing Address - Country:US
Mailing Address - Phone:513-546-8002
Mailing Address - Fax:
Practice Address - Street 1:3285 RENFRO AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6624
Practice Address - Country:US
Practice Address - Phone:513-546-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT187022172A00000X
OHRN284383101YA0400X, 163WC0400X, 163WC2100X, 163WD1100X, 163WE0900X, 163WG0000X, 163WG0100X, 163WG0600X, 163WH0200X, 163WH1000X, 163WP0000X, 163WP2201X, 163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No172A00000XOther Service ProvidersDriver
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care