Provider Demographics
NPI:1356783773
Name:RIOS, TIMOHTY A (LPN)
Entity type:Individual
Prefix:MR
First Name:TIMOHTY
Middle Name:A
Last Name:RIOS
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 1:3073 HILLSIDE MEADOW DR
Mailing Address - Street 2:APT 6
Mailing Address - City:NEWPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13416-3806
Mailing Address - Country:US
Mailing Address - Phone:315-845-6145
Mailing Address - Fax:
Practice Address - Street 1:3073 HILLSIDE MEADOW DR
Practice Address - Street 2:APARTMENT 6, BUILDING 1
Practice Address - City:NEWPORT
Practice Address - State:NY
Practice Address - Zip Code:13416-3806
Practice Address - Country:US
Practice Address - Phone:315-845-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-315072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse