Basic Information
| Provider Information | |||||||||
| NPI: | 1710287891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORCHARD PARK EARLY INTERVENTION RN SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 CENTRE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141274100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166672294 | ||||||||
| FaxNumber: | 7166672272 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 CENTRE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141274100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166672294 | ||||||||
| FaxNumber: | 7166672272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2010 | ||||||||
| LastUpdateDate: | 10/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | WETTLAUFER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7166672294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN MSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.