Healthcare Provider Details

I. General information

NPI: 1285688564
Provider Name (Legal Business Name): KAREN JEANNINE STOWELL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 ELMWOOD AVE
KENMORE NY
14217-1356
US

IV. Provider business mailing address

61 S BLOSSOM RD
ELMA NY
14059-9614
US

V. Phone/Fax

Practice location:
  • Phone: 716-876-4033
  • Fax:
Mailing address:
  • Phone: 716-675-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304365-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: