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General NPI Number Information
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NPI Number | 1164272753
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Entity Type | Individual
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Provider Name | REBECCA C GUBALA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 3980 SHERIDAN DRIVE
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City | AMHERST
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State | NY
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Zip | 14226-1727
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Country | US
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Telephone | 716-541-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 HICKORY LN
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City | NIAGARA FALLS
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State | NY
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Zip | 14304-1442
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Country | US
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Telephone | 716-696-2305
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 353261
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License Number State | NY
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