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General NPI Number Information
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NPI Number | 1639538150
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Entity Type | Organization
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Legal Business Name | MIND-BODY CONNECTION FOR ADULT HEALTH NP, PLLC
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 4511 HARLEM RD
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City | AMHERST
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State | NY
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Zip | 14226-3803
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Country | US
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Telephone | 716-704-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 HARLEM RD
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City | AMHERST
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State | NY
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Zip | 14226-3803
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Country | US
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Telephone | 716-704-5683
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRACTITIONER
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Name | DR. MAUREEN RYAN
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Credential | DNP, NP-C
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Telephone | 716-704-5682
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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 | F300457-1
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License Number State | NY
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