Healthcare Provider Details

I. General information

NPI: 1407282759
Provider Name (Legal Business Name): LIZ OSTROM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

IV. Provider business mailing address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-9016
  • Fax: 716-626-4271
Mailing address:
  • Phone: 716-626-9016
  • Fax: 716-626-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANNE OSTROM
Title or Position: OWNER
Credential: N.P.
Phone: 716-626-9016