Provider Demographics
NPI:1053660357
Name:DODDY, CHRISTINE F (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:DODDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ISLAND BLVD
Mailing Address - Street 2:APT. E
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4919
Mailing Address - Country:US
Mailing Address - Phone:631-740-0323
Mailing Address - Fax:
Practice Address - Street 1:61 ISLAND BLVD
Practice Address - Street 2:APT. E
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4919
Practice Address - Country:US
Practice Address - Phone:631-740-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301497-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse