Provider Demographics
NPI:1104152420
Name:DEGRAN, DOREEN LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:LYNN
Last Name:DEGRAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 WOODSTONE LANE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-576-4873
Mailing Address - Fax:
Practice Address - Street 1:143 WOODSTONE LANE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-576-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504956-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse