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NPI Code Detail

MEDICARE: AMANDA LEE UPDYKE LPN

MEDICARE: AMANDA LEE UPDYKE LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse298497-1NY

General Provider Information

NPI Number : 1396071767
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEE UPDYKE LPN
Provider Business Mailing Address
First Line : 95 NORTH MAIN ST. SUITE 104
Second Line :
City : WELLSVILLE
State : NY
Zip : 14895-1029
Country : US
Telephone Number : 585-610-8604
Fax Number : 585-593-9411
Provider Business Practice Location Address
First Line : 95 NORTH MAIN STREET SUITE 104
Second Line :
City : WELLSVILLE
State : NY
Zip : 14895-9722
Country : US
Telephone Number : 585-610-8604
Fax Number : 585-593-9411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2009
Last Update Date : 12/11/2012

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