Healthcare Provider Details

I. General information

NPI: 1477603298
Provider Name (Legal Business Name): ANN MARIE SMOKOWSKI RD, CDE, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-2137
  • Fax: 716-828-3459
Mailing address:
  • Phone: 716-828-2137
  • Fax: 716-828-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number544469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: