Provider Demographics
NPI:1639638034
Name:CHRISTOPHER, JAMES II (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CHRISTOPHER
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16123 STAR SCHOOL HOUSE ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634-3022
Mailing Address - Country:US
Mailing Address - Phone:315-530-2767
Mailing Address - Fax:
Practice Address - Street 1:16123 STAR SCHOOL HOUSE ROAD EXT
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NY
Practice Address - Zip Code:13634-3022
Practice Address - Country:US
Practice Address - Phone:315-530-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319778164W00000X
FLPN5239360164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse