Provider Demographics
NPI:1700226065
Name:DIKITANAN, THERESE YLANE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:THERESE
Middle Name:YLANE
Last Name:DIKITANAN
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 1:188 AVALON GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-7426
Mailing Address - Country:US
Mailing Address - Phone:845-667-1198
Mailing Address - Fax:
Practice Address - Street 1:188 AVALON GARDENS DR
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-7426
Practice Address - Country:US
Practice Address - Phone:845-667-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304514-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse