Provider Demographics
NPI:1437467560
Name:DITTUS, DENISE
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:DITTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-5222
Mailing Address - Country:US
Mailing Address - Phone:845-247-6874
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5222
Practice Address - Country:US
Practice Address - Phone:845-247-6874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486630-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse