Healthcare Provider Details

I. General information

NPI: 1710973672
Provider Name (Legal Business Name): REBECCA L STOCK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MAPLE RD
WILLIAMSVILLE NY
14221-2918
US

IV. Provider business mailing address

41 MAPLE RD
WILLIAMSVILLE NY
14221-2918
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-1045
  • Fax: 716-631-1365
Mailing address:
  • Phone: 716-631-1045
  • Fax: 716-631-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF4204171
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF4204171
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF4204171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: