=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689812075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVA T SKOMPINSKI N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2009
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2671 HARLEM RD
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14225-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-892-9670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8294 HUNTERS CV
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-4175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-633-3459
-----------------------------------------------------
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 | 304869
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------