Healthcare Provider Details

I. General information

NPI: 1982601175
Provider Name (Legal Business Name): PATRICIA A IACOVITTI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

IV. Provider business mailing address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-1107
  • Fax: 716-298-5737
Mailing address:
  • Phone: 716-298-1107
  • Fax: 716-298-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF3800366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: