Provider Demographics
NPI:1912212911
Name:AMIDON, CHRISTY J
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:J
Last Name:AMIDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FREDERICK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6205
Mailing Address - Country:US
Mailing Address - Phone:315-569-2716
Mailing Address - Fax:
Practice Address - Street 1:118 FREDERICK DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6205
Practice Address - Country:US
Practice Address - Phone:315-569-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297781-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse