Provider Demographics
NPI:1467645309
Name:TRYON, JO ANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:ANNE
Last Name:TRYON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JO
Other - Middle Name:ANNE
Other - Last Name:BACHMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:12 RUST MEMORIAL
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036
Mailing Address - Country:US
Mailing Address - Phone:315-676-9379
Mailing Address - Fax:
Practice Address - Street 1:12 RUST MEMORIAL
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-676-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255190 1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse