Provider Demographics
NPI:1336993047
Name:PALLOTTA, ANITA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:PALLOTTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WADING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-1011
Mailing Address - Country:US
Mailing Address - Phone:163-664-1935
Mailing Address - Fax:
Practice Address - Street 1:17 WADING RIVER RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-1011
Practice Address - Country:US
Practice Address - Phone:163-166-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse