Provider Demographics
NPI:1265002398
Name:THURMOND, AMAYLA JANTONIA (LPN)
Entity Type:Individual
Prefix:
First Name:AMAYLA
Middle Name:JANTONIA
Last Name:THURMOND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMAYLA
Other - Middle Name:JANTONIA
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2713
Mailing Address - Country:US
Mailing Address - Phone:315-719-9056
Mailing Address - Fax:
Practice Address - Street 1:154 S WEST ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2713
Practice Address - Country:US
Practice Address - Phone:315-719-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341426-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse