Provider Demographics
NPI:1821407263
Name:KAFTAN, PERRIN ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:PERRIN
Middle Name:ELIZABETH
Last Name:KAFTAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PERRIN
Other - Middle Name:
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3046
Mailing Address - Country:US
Mailing Address - Phone:315-422-4302
Mailing Address - Fax:
Practice Address - Street 1:128 CIRCLE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3046
Practice Address - Country:US
Practice Address - Phone:315-422-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682433-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health