Healthcare Provider Details

I. General information

NPI: 1700842937
Provider Name (Legal Business Name): ERIKA ANNE ERTL TELBAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

15 N HILL DR
WEST SENECA NY
14224-2582
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-1942
  • Fax:
Mailing address:
  • Phone: 716-668-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number350176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: