Healthcare Provider Details

I. General information

NPI: 1487078564
Provider Name (Legal Business Name): LAURA L CONTRERAS-GOODE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA L CONTRERAS

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-8518
Mailing address:
  • Phone: 716-845-2300
  • Fax: 716-845-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number526599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: