Healthcare Provider Details

I. General information

NPI: 1053625236
Provider Name (Legal Business Name): DAWN M HEZEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 TRANSIT RD STE 141
ELMA NY
14059-9399
US

IV. Provider business mailing address

PO BOX 1375
ELLICOTTVILLE NY
14731-1375
US

V. Phone/Fax

Practice location:
  • Phone: 716-896-2470
  • Fax:
Mailing address:
  • Phone: 716-725-1003
  • Fax: 716-226-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: