Provider Demographics
NPI:1699590703
Name:ESCOBER DORAN, CARISSA CHAN (RN)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:CHAN
Last Name:ESCOBER DORAN
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 1:1580 MASSACHUSETTS AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2925
Mailing Address - Country:US
Mailing Address - Phone:202-262-3832
Mailing Address - Fax:
Practice Address - Street 1:1580 MASSACHUSETTS AVE APT 4D
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2925
Practice Address - Country:US
Practice Address - Phone:202-262-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse