Individual
AMY LYNN PETRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
30951 POOLE RD, THERESA, NY 13691-2234
(315) 405-0888
Mailing address
30951 POOLE RD, THERESA, NY 13691-2234
(315) 405-0888
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
264594
NY
Other
Enumeration date
09/06/2007
Last updated
04/16/2013
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