Provider Demographics
NPI:1245677335
Name:ORTIZ, ANNETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:ORTIZ
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 1:921 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-1843
Mailing Address - Country:US
Mailing Address - Phone:914-215-4212
Mailing Address - Fax:
Practice Address - Street 1:921 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-1843
Practice Address - Country:US
Practice Address - Phone:914-215-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298722-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse