Healthcare Provider Details

I. General information

NPI: 1811631922
Provider Name (Legal Business Name): DARRA LYN HOTOPP REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 PEPPERBUSH PL
BALLSTON SPA NY
12020-4475
US

IV. Provider business mailing address

78 PEPPERBUSH PL
BALLSTON SPA NY
12020-4475
US

V. Phone/Fax

Practice location:
  • Phone: 518-703-9023
  • Fax:
Mailing address:
  • Phone: 518-703-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number626789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: