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General NPI Number Information
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NPI Number | 1902578313
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Entity Type | Individual
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Provider Name | JORDAN RAE VERRALL FNP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 111 N MAPLEMERE RD STE 200
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3182
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Country | US
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Telephone | 716-626-2644
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Fax |
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Provider Business Mailing Address
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Address Line | 726 EXCHANGE ST STE 710
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City | BUFFALO
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State | NY
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Zip | 14210-1464
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Country | US
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Telephone | 716-852-4772
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 347799
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347799
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License Number State | NY
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