Provider Demographics
NPI:1992149462
Name:AMIDON, DEBORAH LU (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LU
Last Name:AMIDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 JAMESVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3211
Mailing Address - Country:US
Mailing Address - Phone:315-435-4563
Mailing Address - Fax:
Practice Address - Street 1:345 JAMESVILLE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3211
Practice Address - Country:US
Practice Address - Phone:315-435-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7471744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse