Healthcare Provider Details

I. General information

NPI: 1215927751
Provider Name (Legal Business Name): JOAN BEATRICE TUDINI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 MAIN ST
EAST AURORA NY
14052-1650
US

IV. Provider business mailing address

292 MAIN STREET
EAST AURORA NY
14052-1560
US

V. Phone/Fax

Practice location:
  • Phone: 716-652-1560
  • Fax: 716-652-0018
Mailing address:
  • Phone: 716-652-1560
  • Fax: 716-652-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF-301348-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number236991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: