Provider Demographics
NPI:1295961340
Name:BOTTIGGI, CARRIE (CNP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:BOTTIGGI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 LANDERBROOK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4071
Mailing Address - Country:US
Mailing Address - Phone:440-646-2515
Mailing Address - Fax:216-201-5370
Practice Address - Street 1:5850 LANDERBROOK DR STE 210
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4071
Practice Address - Country:US
Practice Address - Phone:440-646-2515
Practice Address - Fax:216-201-5370
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10693363LW0102X
OHCOA10693-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2985239Medicaid
OHH029962Medicare PIN