Individual
CLANCY WALLERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22011 145TH RD, SPRINGFIELD GARDENS, NY 11413-3420
(347) 748-2184
Mailing address
22011 145TH RD, SPRINGFIELD GARDENS, NY 11413-3420
(347) 748-2184
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
5510351
NY
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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