Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F302271 | NY |
NPI | 1003918400 |
---|---|
Provider Name | Sue E. Staley |
First Address | Avon, NY 14414-1462 |
Second Address | Canandaigua, NY 14424-1731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 13/12/2013 |