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General NPI Number Information
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NPI Number | 1306611074
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Entity Type | Individual
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Provider Name | KAISHLA MARIE FERNANDEZ RN
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Gender | Female
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 3332 WALDEN AVE
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City | DEPEW
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State | NY
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Zip | 14043-2400
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Country | US
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Telephone | 716-430-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 4768 BROADWAY
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City | DEPEW
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State | NY
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Zip | 14043-3820
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Country | US
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Telephone | 716-430-8995
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 777682-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F354185-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 777682-01
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License Number State | NY
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