Provider Demographics
NPI:1467764589
Name:UTTENDORFER, DANIEL J (RN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:UTTENDORFER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KUKUK LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6943
Mailing Address - Country:US
Mailing Address - Phone:845-336-2616
Mailing Address - Fax:845-336-3302
Practice Address - Street 1:70 KUKUK LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6943
Practice Address - Country:US
Practice Address - Phone:845-336-2616
Practice Address - Fax:845-336-3302
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467495-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool