Doreen Faulk, RN

Key facts

NPI

1841691995

Entity type

Individual (NPI type 1)

Primary specialty

Home Health Agency 251E00000X

License

593154-1 (NY)

Practice address

14 Glenwood CT
Bayport, NY 11705-1429

Phone

(631) 624-0349

Fax

(631) 868-7252

NPI assigned

Sep 9, 2014

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 9, 2014.

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410220800000",
    "number": "1841691995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 GLENWOOD CT",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051429",
            "telephone_number": "631-624-0349",
            "fax_number": "631-868-7252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 GLENWOOD CT",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051429",
            "telephone_number": "631-624-0349",
            "fax_number": "631-868-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAULK",
        "first_name": "DOREEN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-09",
        "last_updated": "2014-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "593154-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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