Healthcare Provider Details

I. General information

NPI: 1336055268
Provider Name (Legal Business Name): ASHLEY NICOLE KROETSCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 DUNLOP AVE
TONAWANDA NY
14150-7839
US

IV. Provider business mailing address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-367-8937
  • Fax:
Mailing address:
  • Phone: 716-845-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number360404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: