Healthcare Provider Details

I. General information

NPI: 1366541427
Provider Name (Legal Business Name): CHRISTIE LEIGH KOEDEL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CARROW ST
ORCHARD PARK NY
14127-2604
US

IV. Provider business mailing address

24 CARROW ST
ORCHARD PARK NY
14127-2604
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-3443
  • Fax: 716-972-0374
Mailing address:
  • Phone: 716-662-3443
  • Fax: 716-972-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: