Individual
MICHAELA JEAN ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
38 SENECA ST, BALDWINSVILLE, NY 13027-2809
(315) 558-0976
Mailing address
38 SENECA ST, BALDWINSVILLE, NY 13027-2809
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
721390
NY
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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