Healthcare Provider Details

I. General information

NPI: 1134531023
Provider Name (Legal Business Name): JOHN FRANCIS REDMOND SR. ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 YOUNGS RD STE 203
BUFFALO NY
14221-8024
US

IV. Provider business mailing address

PO BOX 488
BUFFALO NY
14240-0488
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-9004
  • Fax:
Mailing address:
  • Phone: 866-853-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: