Provider Demographics
NPI:1588404297
Name:HOWARD, AMARRIA DIVINE (LPN)
Entity type:Individual
Prefix:
First Name:AMARRIA
Middle Name:DIVINE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 HAWKS NEST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4848
Mailing Address - Country:US
Mailing Address - Phone:585-642-2642
Mailing Address - Fax:
Practice Address - Street 1:254 HAWKS NEST CIRCLE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4848
Practice Address - Country:US
Practice Address - Phone:585-642-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347122164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse