Basic Information
| Provider Information | |||||||||
| NPI: | 1164783460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADULT HEALTH NURSE PRACTITIONER ALL ABOUT YOU PRIMARY CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | NORTH TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2234 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142102438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163417817 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2012 | ||||||||
| LastUpdateDate: | 06/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | ELMINOWSKI | ||||||||
| AuthorizedOfficialFirstName: | NERFIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7163417817 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.