=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336939594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAURA ANSON AGNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2025
-----------------------------------------------------
Last Update Date | 05/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 MAPLE RD STE 1
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-626-5250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 247 VANDERVOORT ST APT 1
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-7246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-909-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 312206
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------