Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
May 14, 2026
License(s)
312600 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 631293 | Irving, TX 75063-0089 | |
| LOCATION | 4380 MAIN ST | Amherst, NY 14226-3544 | 800-462-7652 |
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