Tiffany Marie Mott, LPN
Individual provider Active NPI Licensed Practical Nurse · Watetown, NY
NPI 1154599280 · NPPES record last updated Feb 12, 2008
Key facts
- NPI
- 1154599280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 273743-1 (NY)
- Practice address
- 30287 Nys RT 12
Watetown, NY 13601 - Phone
- (315) 785-6431
- NPI assigned
- Feb 12, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 273743-1 | NY | Yes |
Addresses
Primary practice location
30287 Nys RT 12
Watetown, NY 13601
Mailing address
30287 Nys RT 12
Watetown, NY 13601
Phone (315) 785-6431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02872168 | Medicaid | NY |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.