Provider Demographics
NPI:1902155880
Name:GARRISON, AMY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-7380
Mailing Address - Country:US
Mailing Address - Phone:518-897-4725
Mailing Address - Fax:
Practice Address - Street 1:203 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1738
Practice Address - Country:US
Practice Address - Phone:518-523-1717
Practice Address - Fax:518-523-8340
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011334363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1386839488OtherDMG INTERNAL MEDICINE NPI#
PA1588635999OtherDR. DAVID GARRISON NPI#
PAG35632Medicare UPIN