Provider Demographics
NPI:1720381171
Name:LIOTTA, CARLA D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:D
Last Name:LIOTTA
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 1:828 HAMLIN PARMA TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9737
Mailing Address - Country:US
Mailing Address - Phone:585-392-2524
Mailing Address - Fax:
Practice Address - Street 1:190 LONGRIDGE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3552
Practice Address - Country:US
Practice Address - Phone:585-966-5805
Practice Address - Fax:585-581-8105
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240422-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse