Provider Demographics
NPI:1003252347
Name:AGNER, HIEDI LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:HIEDI
Middle Name:LYNN
Last Name:AGNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HIEDI
Other - Middle Name:LYNN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4031 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9709
Mailing Address - Country:US
Mailing Address - Phone:315-314-7990
Mailing Address - Fax:
Practice Address - Street 1:4031 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-9709
Practice Address - Country:US
Practice Address - Phone:315-314-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314353-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse