Healthcare Provider Details

I. General information

NPI: 1821226085
Provider Name (Legal Business Name): JAMIE L KOBAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 HARLEM RD SUITE 210
CHEEKTOWAGA NY
14225-4031
US

IV. Provider business mailing address

2625 HARLEM RD SUITE 210
CHEEKTOWAGA NY
14225-4031
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-7337
  • Fax: 716-893-7699
Mailing address:
  • Phone: 716-893-7337
  • Fax: 716-893-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: