Healthcare Provider Details

I. General information

NPI: 1982277968
Provider Name (Legal Business Name): GRACE COYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD
WILLIAMSVILLE NY
14221-5795
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1151
  • Fax: 716-250-5997
Mailing address:
  • Phone: 716-630-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: