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General NPI Number Information
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NPI Number | 1578719894
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Entity Type | Individual
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Provider Name | TINA MARIE MYERS NA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 1211 TRANSIT RD 1211 TRANSIT AVE.
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1481
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Country | US
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Telephone | 716-662-1242
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Fax | 716-662-1242
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Provider Business Mailing Address
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Address Line | 1211 TRANSIT RD 1211 TRANSIT RD.
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1481
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Country | US
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Telephone | 716-662-1242
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Fax | 716-662-1242
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | NA
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | NA
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License Number State | NY
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