Provider Demographics
NPI:1710118039
Name:WOOTAN, HOPE (RN)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:WOOTAN
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 1:107 GREENKILL AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5441
Mailing Address - Country:US
Mailing Address - Phone:845-339-6683
Mailing Address - Fax:
Practice Address - Street 1:107 GREENKILL AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5441
Practice Address - Country:US
Practice Address - Phone:845-339-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY553405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse