Healthcare Provider Details

I. General information

NPI: 1669866125
Provider Name (Legal Business Name): KAITLYN A WOJEWODA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN A HULL FNP

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PROFESSIONAL PKWY
LOCKPORT NY
14094-5369
US

IV. Provider business mailing address

139 PROFESSIONAL PKWY
LOCKPORT NY
14094-5369
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-6711
  • Fax: 716-433-0546
Mailing address:
  • Phone: 716-433-6711
  • Fax: 716-433-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: