Provider Demographics
NPI:1790978047
Name:HUGHES, AMY DARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DARLENE
Last Name:HUGHES
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 1:639 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13625-3161
Mailing Address - Country:US
Mailing Address - Phone:315-379-0410
Mailing Address - Fax:
Practice Address - Street 1:639 WILSON RD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:NY
Practice Address - Zip Code:13625-3161
Practice Address - Country:US
Practice Address - Phone:315-379-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237625-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02557091Medicaid