Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | F301051-1 | NY |
Y | 363LG0600X | Nurse Practitioner - Gerontology | F340061-1 | NY |
NPI | 1053363275 |
---|---|
Provider Name | Ms. Kathleen Rose Douris |
First Address | Brooklyn, NY 11209-1208 |
Second Address | Brooklyn, NY 11209-7104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 06/07/2011 |