Individual
AMANDA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
364 LAKE MARIE RD, LIBERTY, NY 12754-2924
(845) 866-1667
Mailing address
364 LAKE MARIE RD, LIBERTY, NY 12754-2924
(845) 866-1667
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
286438
NY
Other
Enumeration date
06/01/2011
Last updated
06/01/2011
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