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General NPI Number Information
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NPI Number | 1588066468
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Entity Type | Individual
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Provider Name | JESSICA M KOSTREWA NP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 6000 BROCKTON DR
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City | LOCKPORT
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State | NY
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Zip | 14094-9273
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Country | US
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Telephone | 716-845-3400
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Fax | 716-438-1430
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Provider Business Mailing Address
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Address Line | 199 PARK CLUB LN STE 500
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5269
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Country | US
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Telephone | 716-845-1300
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F306893
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F306893
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License Number State | NY
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