Individual
CARLY M PREMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 CONWAY CT, TROY, NY 12180-2108
(518) 274-6525
(518) 274-6511
Mailing address
905 3RD AVE, TROY, NY 12182-1918
(518) 274-6525
(518) 274-6511
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
645882
NY
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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