Provider Demographics
NPI:1225756034
Name:BASLOW, CHRISTY (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:BASLOW
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 1:4308 LYONS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LYONS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13368-2111
Mailing Address - Country:US
Mailing Address - Phone:315-525-5334
Mailing Address - Fax:
Practice Address - Street 1:4308 LYONS FALLS RD
Practice Address - Street 2:
Practice Address - City:LYONS FALLS
Practice Address - State:NY
Practice Address - Zip Code:13368-2111
Practice Address - Country:US
Practice Address - Phone:315-525-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210604164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210604OtherOFFICE OF PROFESSIONS