Provider Demographics
NPI:1154667608
Name:AMOR, KRYSTAL X (LPN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:X
Last Name:AMOR
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 1:36 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2139
Mailing Address - Country:US
Mailing Address - Phone:929-486-2710
Mailing Address - Fax:516-710-7190
Practice Address - Street 1:36 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2139
Practice Address - Country:US
Practice Address - Phone:929-486-2710
Practice Address - Fax:516-710-7190
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse