Provider Demographics
NPI:1770828949
Name:OTTO, VICKI ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:ANN
Last Name:OTTO
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 1:5342 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:NY
Mailing Address - Zip Code:14466-9616
Mailing Address - Country:US
Mailing Address - Phone:585-503-4328
Mailing Address - Fax:
Practice Address - Street 1:5342 COUNTY ROAD 37
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:NY
Practice Address - Zip Code:14466-9616
Practice Address - Country:US
Practice Address - Phone:585-503-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254962-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse