Basic Information
| Provider Information | |||||||||
| NPI: | 1962613968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORTRIGHT | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 376 | ||||||||
| Address2: | 10 CHERRIE LANE | ||||||||
| City: | NEVERSINK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127650376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459857207 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 COMMUNITY LANE | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452928770 | ||||||||
| FaxNumber: | 8452924206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4183371 | NY | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 02258919 | 05 | NY | MEDICAID |