Healthcare Provider Details

I. General information

NPI: 1508281312
Provider Name (Legal Business Name): ANN R DUTCHESS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAKESIDE CLINIC 355 CENTRAL AVE
FREDONIA NY
14063
US

IV. Provider business mailing address

BUFFALO PSYCHIATRIC CENTER 400 FOREST AVE.
BUFFALO NY
14213
US

V. Phone/Fax

Practice location:
  • Phone: 716-672-6117
  • Fax: 716-672-6120
Mailing address:
  • Phone: 716-816-2134
  • Fax: 716-672-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: