Provider Demographics
NPI:1205132529
Name:AMUSO, DAVID MICHAEL (LPN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:AMUSO
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 1:5120 SIMPSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3627
Mailing Address - Country:US
Mailing Address - Phone:717-766-7652
Mailing Address - Fax:717-766-5828
Practice Address - Street 1:5120 SIMPSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3627
Practice Address - Country:US
Practice Address - Phone:717-766-7652
Practice Address - Fax:717-766-5828
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN275425164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN275425OtherLPN LICENSE