Provider Demographics
NPI:1437826906
Name:DENTINO, MAURA (NP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:DENTINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10511 ROSEGATE CT UNIT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-5919
Mailing Address - Country:US
Mailing Address - Phone:309-222-7783
Mailing Address - Fax:
Practice Address - Street 1:10 E 40TH ST FL 29
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0200
Practice Address - Country:US
Practice Address - Phone:212-779-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717643163W00000X
NY403663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse