Individual
NICHOLE S SUPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
274423
NY
390200000X
Student in an Organized Health Care Education/Training Program
LP01965
RI
Other
Enumeration date
07/13/2010
Last updated
10/03/2014
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