Provider Demographics
NPI:1538205968
Name:LALLY, ANNMARIE M (F-NP)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:M
Last Name:LALLY
Suffix:
Gender:F
Credentials:F-NP
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Other - Credentials:
Mailing Address - Street 1:9150 THOMPSONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9775
Mailing Address - Country:US
Mailing Address - Phone:716-741-3137
Mailing Address - Fax:716-741-3137
Practice Address - Street 1:533 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-1810
Practice Address - Country:US
Practice Address - Phone:716-743-5450
Practice Address - Fax:716-743-5455
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF332056-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560375001OtherBLUE CROSS
NY9512250OtherINDEPENDENT HEALTH
NYB4744OtherRAILROAD MEDICARE
NYB4744OtherRAILROAD MEDICARE