Individual
NICOLE R GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3685 SOUTHWESTERN BLVD, ORCHARD PARK, NY 14127-1732
(716) 712-7555
Mailing address
3685 SOUTHWESTERN BLVD, ORCHARD PARK, NY 14127-1732
(716) 712-7555
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
305960
NY
363LA2200X
Adult Health Nurse Practitioner
305960
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F305960
NY
Other
Enumeration date
02/09/2012
Last updated
10/10/2024
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