Healthcare Provider Details

I. General information

NPI: 1356832778
Provider Name (Legal Business Name): TIFFANY TOMOKO NAKAJIMA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2095
US

IV. Provider business mailing address

2491 EMERY RD
SOUTH WALES NY
14139-9408
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: