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Individual
JOANNE DETORE
Active
Individual
JOANNE DETORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006825
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02340921
—
NY
01
—
P00055451
RR MEDICARE
NY
Enumeration date
01/12/2006
Last updated
06/06/2012
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