Provider Demographics
NPI:1770809246
Name:HANNIGAN, DOREEN ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:ELIZABETH
Last Name:HANNIGAN
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 1:23 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LK RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5409
Mailing Address - Country:US
Mailing Address - Phone:631-767-3189
Mailing Address - Fax:
Practice Address - Street 1:124 HOBART ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3402
Practice Address - Country:US
Practice Address - Phone:631-767-3189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355414163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health