=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760732739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE M WALDRAFF RN, LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 01/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 FRANKLIN ST ALL METRO HEALTH CARE SUITE 205
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14202-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-856-2702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 HARLEM RD
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14206-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-895-1126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 514138-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 233425-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------