Healthcare Provider Details

I. General information

NPI: 1134544034
Provider Name (Legal Business Name): SUZANNE MARIE PRINCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NIAGARA ST
BUFFALO NY
14201-1886
US

IV. Provider business mailing address

430 NIAGARA ST
BUFFALO NY
14201-1886
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-2587
  • Fax: 716-856-2608
Mailing address:
  • Phone: 716-856-2587
  • Fax: 716-856-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number22682214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: