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General NPI Number Information
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NPI Number | 1871292953
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Entity Type | Individual
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Provider Name | AWA NDOW PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 1030 ELLICOTT ST
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City | BUFFALO
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State | NY
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Zip | 14209-2127
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Country | US
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Telephone | 716-881-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 308 DODGE ST
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City | BUFFALO
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State | NY
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Zip | 14208-2308
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Country | US
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Telephone | 347-768-5253
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 404170
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License Number State | NY
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