Individual
BRENDA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
100 BALLARD AVE, SYRACUSE, NY 13205-1001
(315) 432-5636
Mailing address
100 BALLARD AVE, SYRACUSE, NY 13205-1001
(315) 432-5636
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
234370-1
NY
Other
Enumeration date
11/11/2011
Last updated
11/11/2011
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