Individual
MRS. AMY SUE TRIVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN LICENSE # 275747
Contact information
Practice address
302 CHARLANE PARKWAY, NORTH SYRACUSE, NY 13212-4211
(315) 402-4518
Mailing address
302 CHARLANE PARKWAY, NORTH SYRACUSE, NY 13212-4211
(315) 402-4518
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
275747
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07762027
—
NY
Enumeration date
05/09/2022
Last updated
04/01/2024
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