Individual
MARY COLLEEN HOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
17 LONG AVENUE, SUITE 110, HAMBURG, NY 14075
(716) 646-5188
(716) 646-5190
Mailing address
17 LONG AVENUE, SUITE 110, HAMBURG, NY 14075
(716) 646-5188
(716) 646-5190
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F3331561
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000560585002
BLUE CROSS BLUE SHIELD
NY
01
—
9512110
IHA
NY
Enumeration date
06/21/2006
Last updated
07/08/2007
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