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General NPI Number Information
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NPI Number | 1457937146
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Entity Type | Individual
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Provider Name | CLARICE TANNEBAUM NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 225 S CASCADE DR
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City | SPRINGVILLE
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State | NY
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Zip | 14141-9287
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Country | US
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Telephone | 716-599-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 417 E STATE ST
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City | SALAMANCA
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State | NY
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Zip | 14779-1227
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Country | US
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Telephone | 716-359-7175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R247845
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347606
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License Number State | NY
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