Healthcare Provider Details

I. General information

NPI: 1497092258
Provider Name (Legal Business Name): KARLA MANCUSO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 4TH ST
BUFFALO NY
14202-2613
US

IV. Provider business mailing address

95 4TH ST
BUFFALO NY
14202-2613
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-3925
  • Fax:
Mailing address:
  • Phone: 716-816-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number424782-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: