Individual
MARY ELLEN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1555 LONG POND RD, DEPARTMENT OF PEDIATRICS, ROCHESTER, NY 14626-4122
(585) 368-4012
(585) 368-4019
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381231
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02573513
—
NY
Enumeration date
07/07/2006
Last updated
04/15/2019
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