Provider Demographics
NPI:1760704324
Name:KELLEHER, DAWN ELIZABETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ELIZABETH
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1802
Mailing Address - Country:US
Mailing Address - Phone:845-549-9684
Mailing Address - Fax:
Practice Address - Street 1:53 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1802
Practice Address - Country:US
Practice Address - Phone:845-549-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257486-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse