Provider Demographics
NPI:1851524151
Name:GERMAIN, TEDDY ALLEN (LPN)
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:ALLEN
Last Name:GERMAIN
Suffix:
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 1:305 GUY PARK AVE
Mailing Address - Street 2:APT. #1
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2245
Mailing Address - Country:US
Mailing Address - Phone:518-775-8023
Mailing Address - Fax:
Practice Address - Street 1:305 GUY PARK AVE.
Practice Address - Street 2:APT. #1
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2243
Practice Address - Country:US
Practice Address - Phone:518-752-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281411-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse