Individual
COLLEEN GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1131 BROADWAY ST, BUFFALO, NY 14212-1501
(716) 896-7422
Mailing address
1526 WALDEN AVE STE 400, CHEEKTOWAGA, NY 14225-4985
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
00492231
NY
Other
Enumeration date
06/12/2009
Last updated
06/12/2009
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