Individual
MARY B CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
658 WATSON RD, FAIRPORT, NY 14450-8503
(585) 737-3809
Mailing address
658 WATSON RD, FAIRPORT, NY 14450-8503
(585) 737-3809
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
3548401
NY
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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