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General NPI Number Information
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NPI Number | 1740219633
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Entity Type | Organization
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Legal Business Name | MOBILE NURSE PRACTITIONERS
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5574 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5452
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Country | US
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Telephone | 716-634-2671
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Fax | 716-634-2673
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Provider Business Mailing Address
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Address Line | 1102 NETHERTON CT
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City | EAST AMHERST
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State | NY
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Zip | 14051-2454
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Country | US
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Telephone | 716-634-2671
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Fax | 716-634-2673
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DONNA KEITH-MCCAIN
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Credential | ANP,GNP
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Telephone | 716-634-2671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F340101
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License Number State | NY
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