Provider Demographics
NPI:1780068767
Name:AVERY, DIONNE (RN)
Entity type:Individual
Prefix:
First Name:DIONNE
Middle Name:
Last Name:AVERY
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 1:445 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2017
Mailing Address - Country:US
Mailing Address - Phone:718-270-4718
Mailing Address - Fax:718-270-2653
Practice Address - Street 1:470 CLARKSON AVE STE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-1896
Practice Address - Fax:718-270-2653
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-19
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686926-1163W00000X
NYF340310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY00695941Medicaid
NY331944Medicare Oscar/Certification
NY331952Medicare Oscar/Certification