Provider Demographics
NPI:1295854248
Name:LITTMANN, DENISE ALICE (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ALICE
Last Name:LITTMANN
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 1:57 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3401
Mailing Address - Country:US
Mailing Address - Phone:631-243-5282
Mailing Address - Fax:
Practice Address - Street 1:689 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7501
Practice Address - Country:US
Practice Address - Phone:631-854-4400
Practice Address - Fax:631-854-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330311-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)