Provider Demographics
NPI:1750947123
Name:CHANDLER, AMANDA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:CHANDLER
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 1:4710 ROUTE 305
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-9729
Mailing Address - Country:US
Mailing Address - Phone:585-808-2013
Mailing Address - Fax:
Practice Address - Street 1:4710 ROUTE 305
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-9729
Practice Address - Country:US
Practice Address - Phone:585-808-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse