Provider Demographics
NPI:1225690423
Name:GAUSE, AMANDA ALYSSA (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ALYSSA
Last Name:GAUSE
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 1:40 SUSAN LN APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4909
Mailing Address - Country:US
Mailing Address - Phone:585-305-3508
Mailing Address - Fax:
Practice Address - Street 1:40 SUSAN LN APT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4909
Practice Address - Country:US
Practice Address - Phone:585-305-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328925164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse