Provider Demographics
NPI:1700148897
Name:DATTERO, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DATTERO
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 1:276 GREAT RIVER RD
Mailing Address - Street 2:PO BOX 609
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-3011
Mailing Address - Country:US
Mailing Address - Phone:631-224-9443
Mailing Address - Fax:
Practice Address - Street 1:276 GREAT RIVER RD
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-3011
Practice Address - Country:US
Practice Address - Phone:631-224-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist