Individual
AISHIA SYMONE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
41 OCONNOR RD, FAIRPORT, NY 14450-1327
(585) 383-2216
Mailing address
41 OCONNOR RD, FAIRPORT, NY 14450-1327
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
747632
NY
363LF0000X
Family Nurse Practitioner
Primary
352346
NY
Other
Enumeration date
08/13/2019
Last updated
08/16/2024
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