Provider Demographics
NPI:1255003620
Name:MINOTT, KARLA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:
Last Name:MINOTT
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 1:33 REV CLINTON C BOONE PL
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5509
Mailing Address - Country:US
Mailing Address - Phone:347-451-7526
Mailing Address - Fax:
Practice Address - Street 1:300 E OVERLOOK
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4730
Practice Address - Country:US
Practice Address - Phone:516-472-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332560-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse