Provider Demographics
NPI:1467898783
Name:NOTTELMAN, ANDREW JOHN CARL (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN CARL
Last Name:NOTTELMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MARSDEN RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3313
Mailing Address - Country:US
Mailing Address - Phone:315-657-5861
Mailing Address - Fax:
Practice Address - Street 1:116 MARSDEN RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3313
Practice Address - Country:US
Practice Address - Phone:315-657-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290626164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse