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General NPI Number Information
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NPI Number | 1053846162
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Entity Type | Individual
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Provider Name | CONNIE WOROSZYLO
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 1751 SHERIDAN DR
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City | TONAWANDA
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State | NY
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Zip | 14223-1211
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Country | US
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Telephone | 716-541-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 45672 EDGE MILL CT
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City | GREAT MILLS
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State | MD
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Zip | 20634-3312
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Country | US
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Telephone | 219-306-2880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209024842
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704380894
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0030892
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 341686
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License Number State | NY
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