Individual
MICHAEL WILLIAM DEFORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
146 NORTH ST, AUBURN, NY 13021-3543
(315) 253-0341
(315) 253-1077
Mailing address
146 NORTH ST, AUBURN, NY 13021-3543
(315) 253-0341
(315) 253-1077
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
720937
NY
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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