Healthcare Provider Details

I. General information

NPI: 1902155880
Provider Name (Legal Business Name): AMY GARRISON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OLD MILITARY RD
LAKE PLACID NY
12946-1738
US

IV. Provider business mailing address

PO BOX 1380
SARANAC LAKE NY
12983-7380
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-1717
  • Fax: 518-523-8340
Mailing address:
  • Phone: 518-897-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011334
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: