Provider Demographics
NPI:1326428590
Name:BOTTINI, TAMMY MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:BOTTINI
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 1:1155 MCQUADE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3207
Mailing Address - Country:US
Mailing Address - Phone:315-790-4674
Mailing Address - Fax:315-235-7691
Practice Address - Street 1:1155 MCQUADE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3207
Practice Address - Country:US
Practice Address - Phone:315-790-4674
Practice Address - Fax:315-235-7691
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse