Individual
AMBER FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
263 BLUE POINT AVE, BLUE POINT, NY 11715-1224
(631) 419-6737
Mailing address
16 VAUTRIN AVE, HOLTSVILLE, NY 11742-1624
(631) 960-6124
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
305959
NY
Other
Enumeration date
07/11/2012
Last updated
07/11/2012
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