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General NPI Number Information
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NPI Number | 1629792783
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Entity Type | Individual
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Provider Name | AMANDA LYNN CLARK LPN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 122 PARK AVE
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City | SCHENECTADY
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State | NY
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Zip | 12304-1628
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Country | US
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Telephone | 518-346-2387
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Fax |
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Provider Business Mailing Address
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Address Line | 204 GLEBE ST
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City | JOHNSTOWN
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State | NY
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Zip | 12095-2515
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Country | US
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Telephone | 518-224-8452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5249837
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 329692
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License Number State | NY
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