Provider Demographics
NPI:1760622963
Name:SETESAK, AMY NOELLE (RN)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:NOELLE
Last Name:SETESAK
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 1:94 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8313
Mailing Address - Country:US
Mailing Address - Phone:203-790-7564
Mailing Address - Fax:
Practice Address - Street 1:94 CAROL ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8313
Practice Address - Country:US
Practice Address - Phone:203-790-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT086993163W00000X
NY611438163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse