Provider Demographics
NPI:1528345246
Name:OTTESEN, CAROL ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROL ANN
Middle Name:
Last Name:OTTESEN
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 1:19 VEDDER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1509
Mailing Address - Country:US
Mailing Address - Phone:718-370-2975
Mailing Address - Fax:
Practice Address - Street 1:19 VEDDER AVE.
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1509
Practice Address - Country:US
Practice Address - Phone:718-370-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse