Provider Demographics
NPI:1588857676
Name:LYKE, MARTHA GARLOW (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:GARLOW
Last Name:LYKE
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 1:16212 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:NY
Mailing Address - Zip Code:14476-9737
Mailing Address - Country:US
Mailing Address - Phone:585-659-2572
Mailing Address - Fax:
Practice Address - Street 1:16212 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:NY
Practice Address - Zip Code:14476-9737
Practice Address - Country:US
Practice Address - Phone:585-659-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801930Medicaid