Provider Demographics
NPI:1467822965
Name:BOYER, AMANDA ALEXIS (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ALEXIS
Last Name:BOYER
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 1:68 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7802
Mailing Address - Country:US
Mailing Address - Phone:631-236-5510
Mailing Address - Fax:
Practice Address - Street 1:68 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7802
Practice Address - Country:US
Practice Address - Phone:631-236-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse