Healthcare Provider Details

I. General information

NPI: 1174807390
Provider Name (Legal Business Name): MRS. SUSAN LABUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ROCK CITY ST
LITTLE VALLEY NY
14755-1221
US

IV. Provider business mailing address

207 ROCK CITY ST
LITTLE VALLEY NY
14755-1221
US

V. Phone/Fax

Practice location:
  • Phone: 716-938-9155
  • Fax: 716-938-6576
Mailing address:
  • Phone: 716-938-9155
  • Fax: 716-938-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number390627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: