Healthcare Provider Details

I. General information

NPI: 1588981559
Provider Name (Legal Business Name): PAUL STEVEN ATWELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CENTRAL AVE
FREDONIA NY
14063-1132
US

IV. Provider business mailing address

355 CENTRAL AVE
FREDONIA NY
14063-1132
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423490-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: