Provider Demographics
NPI:1447691068
Name:HAUGHTON, DAMETRESS MARYLAND (LPN)
Entity type:Individual
Prefix:MRS
First Name:DAMETRESS
Middle Name:MARYLAND
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DAMETRESS
Other - Middle Name:MARYLAND
Other - Last Name:MAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2303 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303
Mailing Address - Country:US
Mailing Address - Phone:518-881-8967
Mailing Address - Fax:
Practice Address - Street 1:2303 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:ROTTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-881-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274686-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse