Individual
SALLY MANOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
84 NIGHTENGALE AVE, MASSENA, NY 13662-2538
(315) 764-3720
(315) 764-3723
Mailing address
13695 STATE HIGHWAY 37, MASSENA, NY 13662-3120
(315) 764-3700
(315) 764-3723
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
293058-1
NY
Other
Enumeration date
09/28/2011
Last updated
12/20/2011
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