Healthcare Provider Details

I. General information

NPI: 1437343522
Provider Name (Legal Business Name): CRYSTAL CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SENECA ST
BUFFALO NY
14210-2324
US

IV. Provider business mailing address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-0560
  • Fax: 716-828-1522
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number630988
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: