Healthcare Provider Details

I. General information

NPI: 1750889853
Provider Name (Legal Business Name): JEREMY OOSTERKAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number746306
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number623654
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: