Provider Demographics
NPI:1841323292
Name:COOTS, DEBORAH P (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:P
Last Name:COOTS
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 1:6274 N VINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9677
Mailing Address - Country:US
Mailing Address - Phone:585-554-4018
Mailing Address - Fax:
Practice Address - Street 1:VAMC
Practice Address - Street 2:400 FORTHILL AVE
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14544
Practice Address - Country:US
Practice Address - Phone:585-393-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306407-1311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)