Provider Demographics
NPI:1316055882
Name:DETUCCI, DOREEN ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ANN
Last Name:DETUCCI
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:KAUAI COMMUNITY MENTAL HEALTH CENTER
Mailing Address - Street 2:3 3212 KUHIO HWY
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1142
Mailing Address - Country:US
Mailing Address - Phone:808-274-3190
Mailing Address - Fax:808-274-3194
Practice Address - Street 1:KAUAI COMMUNITY MENTAL HEALTH CENTER
Practice Address - Street 2:3 3212 KUHIO HWY
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1142
Practice Address - Country:US
Practice Address - Phone:808-274-3190
Practice Address - Fax:808-274-3194
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-56769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse