Individual
JESSICA MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
297 SPINDRIFT DR, WILLIAMSVILLE, NY 14221-7894
(716) 831-2600
Mailing address
297 SPINDRIFT DR, WILLIAMSVILLE, NY 14221-7894
(716) 831-2600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
341884
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04831605
—
NY
Enumeration date
06/27/2017
Last updated
11/22/2021
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