Individual
AMANDA ASHLEY RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
178 WILLIAM ST, GENEVA, NY 14456-2554
(315) 830-8591
Mailing address
178 WILLIAM ST, GENEVA, NY 14456-2554
(315) 830-8591
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
327739
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
327739
LPN
NY
Enumeration date
10/09/2018
Last updated
10/09/2018
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