Healthcare Provider Details

I. General information

NPI: 1275817660
Provider Name (Legal Business Name): DANA M HOTALING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PARK AVE
ALBANY NY
12202-1742
US

IV. Provider business mailing address

75 PARK AVE
ALBANY NY
12202-1742
US

V. Phone/Fax

Practice location:
  • Phone: 518-694-5005
  • Fax: 518-694-5012
Mailing address:
  • Phone: 518-694-5005
  • Fax: 518-694-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number468986-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: