Provider Demographics
NPI:1255748463
Name:VINCENT, CHRISTOPHER LEE (LPN)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:VINCENT
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 1:28324 COUNTY ROUTE 54
Mailing Address - Street 2:
Mailing Address - City:CHAUMONT
Mailing Address - State:NY
Mailing Address - Zip Code:13622-2416
Mailing Address - Country:US
Mailing Address - Phone:315-649-5791
Mailing Address - Fax:
Practice Address - Street 1:28324 COUNTY ROUTE 54
Practice Address - Street 2:
Practice Address - City:CHAUMONT
Practice Address - State:NY
Practice Address - Zip Code:13622-2416
Practice Address - Country:US
Practice Address - Phone:315-649-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318455-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse