MEDICARE: MRS. KATHLEEN F COURTNEY C.F.N.P.

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	363LF0000X	Family Nurse Practitioner	F334067-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161570481	OTHER	NY	COMMERCIAL INSURANCE
2	00027259101	OTHER	NY	UNIVERA HEALTHCARE/EXCELL

General Provider Information

NPI Number	:	1912992116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN F COURTNEY C.F.N.P.

Provider Business Mailing Address
First Line	:	50 BRIGHAM RD
Second Line	:
City	:	FREDONIA
State	:	NY
Zip	:	14063-1004
Country	:	US
Telephone Number	:	716-673-1761
Fax Number	:	716-672-7691

Provider Business Practice Location Address
First Line	:	219 BRYANT ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2006
Country	:	US
Telephone Number	:	716-878-7000
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	05/01/2009

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