Individual
CASEY MCIVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9 ANNA DR, BOWMANSVILLE, NY 14026-1017
(716) 331-6882
Mailing address
9 ANNA DR, BOWMANSVILLE, NY 14026-1017
(716) 331-6882
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
332059
NY
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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