Provider Demographics
NPI:1598235442
Name:DART, AMBER KALINA (LPN; LMT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:KALINA
Last Name:DART
Suffix:
Gender:F
Credentials:LPN; LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:HENSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12439-5215
Mailing Address - Country:US
Mailing Address - Phone:518-764-2280
Mailing Address - Fax:
Practice Address - Street 1:536 MAIN STREET UNIT E
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-1241
Practice Address - Country:US
Practice Address - Phone:518-764-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032409225700000X
NY316665164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY316665OtherLPN