Healthcare Provider Details

I. General information

NPI: 1376862268
Provider Name (Legal Business Name): DAWN M DE NISCO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 08/23/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax:
Mailing address:
  • Phone: 716-632-1088
  • Fax: 716-632-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number528186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: