Provider Demographics
NPI:1407126295
Name:CAROLI, LYNETTE J (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:J
Last Name:CAROLI
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 1:1175 STATE ROUTE 17K
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2245
Mailing Address - Country:US
Mailing Address - Phone:845-457-2400
Mailing Address - Fax:845-457-4056
Practice Address - Street 1:1175 STATE ROUTE 17K
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2245
Practice Address - Country:US
Practice Address - Phone:845-457-2400
Practice Address - Fax:845-457-4056
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287150-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool