Provider Demographics
NPI:1053363275
Name:DOURIS, KATHLEEN ROSE (APRN, MSN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ROSE
Last Name:DOURIS
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Gender:F
Credentials:APRN, MSN
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Mailing Address - Street 1:9322 THIRD AVENUE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1208
Mailing Address - Country:US
Mailing Address - Phone:718-630-3730
Mailing Address - Fax:718-630-2970
Practice Address - Street 1:800 POLY PL # 11H
Practice Address - Street 2:NEW YORK HARBOR VA HEALTH CARE SYSTEM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-3730
Practice Address - Fax:718-630-2970
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-07-06
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Provider Licenses
StateLicense IDTaxonomies
NYF301051-1363LA2200X
NYF340061-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health