Individual
LORIE ANN NELLENBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1330 COUNTY ROAD 132, OVID, NY 14521-9700
(315) 835-6136
Mailing address
PO BOX 421, WEEDSPORT, NY 13166-0421
(315) 406-5161
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402660-01
NY
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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