Healthcare Provider Details

I. General information

NPI: 1740219633
Provider Name (Legal Business Name): MOBILE NURSE PRACTITIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5574 MAIN ST
WILLIAMSVILLE NY
14221-5452
US

IV. Provider business mailing address

1102 NETHERTON CT
EAST AMHERST NY
14051-2454
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-2671
  • Fax: 716-634-2673
Mailing address:
  • Phone: 716-634-2671
  • Fax: 716-634-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340101
License Number StateNY

VIII. Authorized Official

Name: MRS. DONNA KEITH-MCCAIN
Title or Position: PRESIDENT
Credential: ANP,GNP
Phone: 716-634-2671