Provider Demographics
NPI:1104155704
Name:ALTARO, KIMBERLY MELISSA (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MELISSA
Last Name:ALTARO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:MELISSA
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12 MARK LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1433
Mailing Address - Country:US
Mailing Address - Phone:917-817-8450
Mailing Address - Fax:
Practice Address - Street 1:12 MARK LN
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1433
Practice Address - Country:US
Practice Address - Phone:917-817-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse