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General NPI Number Information
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NPI Number | 1508332297
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE AND CONSULTING, LLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 3024 NIAGARA FALLS BLVD STE 116
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1116
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Country | US
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Telephone | 716-217-4321
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Fax | 716-219-2469
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Provider Business Mailing Address
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Address Line | 2 RUNNING BROOK DRIVE 2 RUNNING BROOK DRIVE
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City | LANCASTER
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State | NY
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Zip | 14086
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Country | US
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Telephone | 716-864-6316
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA M DAVIS WHEELER
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Credential | NP
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Telephone | 716-217-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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