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Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1114093069

Individual Registrant:
Gender: F
Not Sole Proprietor

Location and contact information for practice:
3023 ROUTE 430  GREENHURST, NY 14742 US
Tel: 716-483-5000  Fax: 716-985-6640

Contact information for business:
Tel: 716-569-2094  Fax: --

Registration Information:
NPI: 1114093069
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Legacy codes, insurance codes and state license numbers:



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