Healthcare Provider Details

I. General information

NPI: 1558328112
Provider Name (Legal Business Name): CRYSTAL BREIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KLEIN RD
WILLIAMSVILLE NY
14221-1713
US

IV. Provider business mailing address

20 ROB ROY PKWY
GRAND ISLAND NY
14072-1321
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-6137
  • Fax: 716-568-6130
Mailing address:
  • Phone: 716-773-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3324741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: