Individual
AMANDA FANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2851 MCCURDY RD, WELLSVILLE, NY 14895-9438
(585) 802-9804
Mailing address
2851 MCCURDY RD, WELLSVILLE, NY 14895-9438
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
294389
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
294389
LPN
NY
01
—
792612539
DRIVERS LICENSE
NY
Enumeration date
04/05/2018
Last updated
06/16/2018
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