Provider Demographics
NPI:1962613968
Name:KORTRIGHT, DAWN LYNETTE (RN)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:LYNETTE
Last Name:KORTRIGHT
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:PO BOX 376
Mailing Address - Street 2:10 CHERRIE LANE
Mailing Address - City:NEVERSINK
Mailing Address - State:NY
Mailing Address - Zip Code:12765-0376
Mailing Address - Country:US
Mailing Address - Phone:845-985-7207
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754
Practice Address - Country:US
Practice Address - Phone:845-292-8770
Practice Address - Fax:845-292-4206
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4183371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258919Medicaid