Provider Demographics
NPI:1356619357
Name:DORO, KRISTIENNA M (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIENNA
Middle Name:M
Last Name:DORO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:14 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-2184
Practice Address - Country:US
Practice Address - Phone:518-459-5273
Practice Address - Fax:518-489-5790
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF339634363LF0000X, 363LF0000X
NY700033163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04204459Medicaid
NYJ400325644Medicare PIN