Provider Demographics
NPI:1811631922
Name:HOTOPP, DARRA LYN (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:DARRA
Middle Name:LYN
Last Name:HOTOPP
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PEPPERBUSH PL
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4475
Mailing Address - Country:US
Mailing Address - Phone:518-703-9023
Mailing Address - Fax:
Practice Address - Street 1:78 PEPPERBUSH PL
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4475
Practice Address - Country:US
Practice Address - Phone:518-703-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626789163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse