Individual
MISS ALYSE RENEE KICKBUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5165 ROUTE 62, CONEWANGO VALLEY, NY 14726-9713
(716) 352-1593
Mailing address
5165 ROUTE 62, CONEWANGO VALLEY, NY 14726-9713
(716) 352-1593
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
322718
NY
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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