Provider Demographics
NPI:1275808297
Name:DETOTA, CAROLINE BERNADETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:BERNADETTE
Last Name:DETOTA
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 1:100 LINDENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2742
Mailing Address - Country:US
Mailing Address - Phone:718-356-4907
Mailing Address - Fax:718-356-2065
Practice Address - Street 1:100 LINDENWOOD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2742
Practice Address - Country:US
Practice Address - Phone:718-356-4907
Practice Address - Fax:718-356-2065
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324474-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool