Provider Demographics
NPI:1174112353
Name:LORUSSO, AMANDA MARIE (LMT, AEMT, BS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:LORUSSO
Suffix:
Gender:F
Credentials:LMT, AEMT, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SACO ST UNIT 87
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4212
Mailing Address - Country:US
Mailing Address - Phone:203-841-6799
Mailing Address - Fax:
Practice Address - Street 1:13 MARCH FARM WAY
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-6234
Practice Address - Country:US
Practice Address - Phone:603-380-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33845146M00000X
NH7550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate