Healthcare Provider Details

I. General information

NPI: 1780309039
Provider Name (Legal Business Name): MANDI RANEE KUPPEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E 3RD ST
DUNKIRK NY
14048-2239
US

IV. Provider business mailing address

75 E 3RD ST
DUNKIRK NY
14048-2239
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-6036
  • Fax: 833-974-1992
Mailing address:
  • Phone: 716-363-6050
  • Fax: 833-974-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: