Provider Demographics
NPI:1871649665
Name:CARUTASU, DENISE M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:CARUTASU
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 1:422 SAND CREEK RD
Mailing Address - Street 2:APT 429
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2735
Mailing Address - Country:US
Mailing Address - Phone:518-275-0051
Mailing Address - Fax:
Practice Address - Street 1:422 SAND CREEK RD
Practice Address - Street 2:APT 429
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2735
Practice Address - Country:US
Practice Address - Phone:518-275-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200448-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569955Medicaid