Provider Demographics
NPI:1578100228
Name:FRYE, CHRISTIAN JOY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTIAN
Middle Name:JOY
Last Name:FRYE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CHRISTIAN
Other - Middle Name:JOY
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:139 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2515
Mailing Address - Country:US
Mailing Address - Phone:516-972-3148
Mailing Address - Fax:
Practice Address - Street 1:139 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2515
Practice Address - Country:US
Practice Address - Phone:516-972-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse