Individual
AMANDA MARY BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
304 GLENGARY RD, SCHENECTADY, NY 12304-4772
(518) 577-5698
Mailing address
304 GLENGARY RD, SCHENECTADY, NY 12304-4772
(518) 577-5698
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
327227
NY
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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