Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F346878 | NY |
NPI | 1093317588 |
---|---|
Provider Name | Mallory Furniss |
First Address | Williamsville, NY 14221-8096 |
Second Address | West Amherst, NY 14228-2044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2020 |
Last Update Date | 10/11/2020 |