Individual
LISA ANNE DANNEBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 BEATTIE AVE, LOCKPORT, NY 14094-5023
(716) 478-4780
Mailing address
5670 KECK RD, LOCKPORT, NY 14094-9307
(716) 946-2548
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
417196
NY
Other
Enumeration date
11/06/2019
Last updated
11/06/2019
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