Provider Demographics
NPI:1811240484
Name:CLOTTEY, NII AWULEY (LPN)
Entity type:Individual
Prefix:MR
First Name:NII
Middle Name:AWULEY
Last Name:CLOTTEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 AVENUE J
Mailing Address - Street 2:PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4337
Mailing Address - Country:US
Mailing Address - Phone:646-745-0628
Mailing Address - Fax:
Practice Address - Street 1:3615 AVENUE J
Practice Address - Street 2:PH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4337
Practice Address - Country:US
Practice Address - Phone:646-745-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310238-1164W00000X
NY021685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No164W00000XNursing Service ProvidersLicensed Practical Nurse