Individual
DR. KELLYROSE MARY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8745 LAKE STREET RD, LE ROY, NY 14482-9344
(585) 768-2620
Mailing address
8745 LAKE STREET RD, LE ROY, NY 14482-9344
(585) 768-2620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
279405
NY
Other
Enumeration date
04/20/2012
Last updated
06/28/2023
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