Healthcare Provider Details

I. General information

NPI: 1528122744
Provider Name (Legal Business Name): BETH ANN WESLOW AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 ERIE RD
DERBY NY
14047-9591
US

IV. Provider business mailing address

4979 HARLEM RD
AMHERST NY
14226-2547
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-9147
  • Fax: 716-947-5175
Mailing address:
  • Phone: 716-923-4380
  • Fax: 716-923-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number267855
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: