Most Relevant Information
Provider Data
| NPI Number: | 1003261322 |
| Provider Name: | JERRY L CORP PMHNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 402647 |
Most Important Dates
| Enumeration Date: | 04/25/2016 |
| Last Updated: | 02/07/2020 |
Provider Practice Location
255 DELAWARE AVE
BUFFALO
NY
142022016
Practice Location Phone/Fax
| Phone: | 7168840888 |
| Fax: |
Provider Mailing Location
255 DELAWARE AVE
BUFFALO
NY
142022016
Provider Mailing Phone/Fax
| Phone: | 7168840888 |
| Fax: |