Healthcare Provider Details

I. General information

NPI: 1669135000
Provider Name (Legal Business Name): ALIVIA RAE CALDWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220
US

IV. Provider business mailing address

450 DICK RD. APT A3
DEPEW NY
14043
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-7000
  • Fax:
Mailing address:
  • Phone: 716-253-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number703336-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347836-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: