Individual
MISS AMANDA MARY HURRINUS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
161 LAKE SHORE RD, LAKE RONKONKOMA, NY 11779-3194
(631) 471-5666
Mailing address
221 E MAIN ST APT 227, RIVERHEAD, NY 11901-2458
(631) 428-3146
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
337340
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164W00000X
—
NY
Enumeration date
07/18/2022
Last updated
07/18/2022
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