Healthcare Provider Details

I. General information

NPI: 1982276242
Provider Name (Legal Business Name): MS. AMBER JO LEMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/20/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

29 BEARD AVE
BUFFALO NY
14214-1603
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone: 515-991-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number808670-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: