Individual
AMY TILLMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 MCCLELLAN ST, PORT BYRON, NY 13140-7706
(315) 209-3771
Mailing address
PO BOX 142, 20 MCCLELLAN ST, PORT BYRON, NY 13140
(315) 209-3771
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
298083
NY
Other
Enumeration date
01/25/2016
Last updated
01/25/2016
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