Individual
CHANCE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17 FACTORY ST, CLEVELAND, NY 13042-3146
(360) 631-8567
Mailing address
17 FACTORY ST, CLEVELAND, NY 13042-3146
(315) 675-3054
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10292877
NY
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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