Individual
LERA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
96 STARK ST, WATERLOO, NY 13165-8807
(315) 539-1555
Mailing address
96 STARK ST, WATERLOO, NY 13165-8807
(315) 539-1555
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
796359
NY
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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