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General NPI Number Information
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NPI Number | 1881730489
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Entity Type | Individual
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Provider Name | KELLY A MAROTTA FNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1150 YOUNGS RD STE 202
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8024
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Country | US
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Telephone | 716-636-9004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | BUFFALO
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State | NY
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Zip | 14240-0488
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Country | US
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Telephone | 668-539-5518
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Fax | 203-916-1041
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 521501
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 335120
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License Number State | NY
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