Provider Demographics
NPI:1356848618
Name:SCHRIVER, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCHRIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 COUNTY HIGHWAY 2 APT 1
Mailing Address - Street 2:
Mailing Address - City:DELANCEY
Mailing Address - State:NY
Mailing Address - Zip Code:13752-3107
Mailing Address - Country:US
Mailing Address - Phone:607-746-2664
Mailing Address - Fax:
Practice Address - Street 1:594 COUNTY HIGHWAY 2 APT 1
Practice Address - Street 2:
Practice Address - City:DELANCEY
Practice Address - State:NY
Practice Address - Zip Code:13752-3107
Practice Address - Country:US
Practice Address - Phone:607-746-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329657164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse