Provider Demographics
NPI:1699006924
Name:PRYOR, ROXANNE M (LPN)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:M
Last Name:PRYOR
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 1:2580 COUNTY ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-3671
Mailing Address - Country:US
Mailing Address - Phone:315-532-3970
Mailing Address - Fax:
Practice Address - Street 1:66 HAWLEY STREET
Practice Address - Street 2:66 HAWLEY ST.,
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-1015
Practice Address - Country:US
Practice Address - Phone:607-772-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159803164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse