Individual
MARY GWYNNE TILLOTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
621 10TH ST, NIAGARA FALLS, NY 14301-1813
(716) 278-4541
(716) 278-4544
Mailing address
621 10TH ST, NIAGARA FALLS, NY 14301-1813
(716) 278-4541
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403249
NY
Other
Enumeration date
10/28/2020
Last updated
01/20/2022
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