Provider Demographics
NPI:1023880085
Name:SANTAMOUR, AMY J (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:SANTAMOUR
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 1:4264 EAST RD
Mailing Address - Street 2:
Mailing Address - City:TURIN
Mailing Address - State:NY
Mailing Address - Zip Code:13473-1704
Mailing Address - Country:US
Mailing Address - Phone:315-348-2500
Mailing Address - Fax:315-348-2510
Practice Address - Street 1:4264 EAST RD
Practice Address - Street 2:
Practice Address - City:TURIN
Practice Address - State:NY
Practice Address - Zip Code:13473-1704
Practice Address - Country:US
Practice Address - Phone:315-348-2500
Practice Address - Fax:315-348-2510
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse