Provider Demographics
NPI:1134618457
Name:KITTLEMAN, CARRIE L (LPN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:KITTLEMAN
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 1:3264 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONSTABLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13325-2422
Mailing Address - Country:US
Mailing Address - Phone:315-297-7715
Mailing Address - Fax:
Practice Address - Street 1:12719 STATE ROUTE 46
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-4356
Practice Address - Country:US
Practice Address - Phone:315-942-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302658-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse