Provider Demographics
NPI:1710129424
Name:WITHERSPOON, DENISE LORETTA (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LORETTA
Last Name:WITHERSPOON
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 1:310 PROSPECT AVE
Mailing Address - Street 2:APT 444
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7760
Mailing Address - Country:US
Mailing Address - Phone:201-880-5762
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVENUE
Practice Address - Street 2:URGENT CARE CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-639-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13551100163WE0003X
NY411270-1163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WE0003XNursing Service ProvidersRegistered NurseEmergency