Individual
CHRISTINE LYNN DEFOREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6644 PINE RIDGE RD, AUBURN, NY 13021-8789
(607) 437-1749
Mailing address
6644 PINE RIDGE RD, AUBURN, NY 13021-8789
(607) 437-1749
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303186-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE
—
NY
Enumeration date
08/19/2020
Last updated
08/19/2020
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