Healthcare Provider Details

I. General information

NPI: 1619998374
Provider Name (Legal Business Name): BETSEY DECHERT-BOSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSEY DECHERT

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

Practice location:
  • Phone: 716-972-0279
  • Fax: 716-972-0273
Mailing address:
  • Phone: 716-972-0279
  • Fax: 716-972-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330430
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number389449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: