Individual
NICOLE ALANA NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
665 AYRAULT RD, FAIRPORT, NY 14450-3000
(585) 421-2067
Mailing address
35 WILLOWICK DR, FAIRPORT, NY 14450-8904
(585) 245-3422
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
715382
NY
Other
Enumeration date
11/23/2021
Last updated
11/23/2021
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