Provider Demographics
NPI:1710612585
Name:HURRINUS, AMANDA MARY I (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MARY
Last Name:HURRINUS
Suffix:I
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 1:221 E MAIN ST APT 227
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2458
Mailing Address - Country:US
Mailing Address - Phone:631-428-3146
Mailing Address - Fax:
Practice Address - Street 1:161 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3194
Practice Address - Country:US
Practice Address - Phone:631-471-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337340164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY164W00000XMedicaid