Provider Demographics
NPI:1093440364
Name:MARCHANT, AMANDA C (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:MARCHANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5326
Mailing Address - Country:US
Mailing Address - Phone:845-399-5585
Mailing Address - Fax:
Practice Address - Street 1:194 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443-5326
Practice Address - Country:US
Practice Address - Phone:845-399-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312252-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse