Healthcare Provider Details

I. General information

NPI: 1821694357
Provider Name (Legal Business Name): ANDREW ROBERT WURSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST STE 300
BUFFALO NY
14202-1102
US

IV. Provider business mailing address

1010 MAIN ST STE 300
BUFFALO NY
14202-1102
US

V. Phone/Fax

Practice location:
  • Phone: 716-896-2470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: