MEDICARE: LATRINA DUBOIS-HORNSBY APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	310157	NY

General Provider Information

NPI Number	:	1609457332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRINA DUBOIS-HORNSBY APN

Provider Business Mailing Address
First Line	:	40 BIRCH PL UPPR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3002
Country	:	US
Telephone Number	:	716-897-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 BIRCH PL UPPR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3002
Country	:	US
Telephone Number	:	716-897-1184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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