Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402713 | NY |
NPI | 1013470350 |
---|---|
Provider Name | Amy Kotarski |
First Address | Buffalo, NY 14202-1804 |
Second Address | Buffalo, NY 14202-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 02/07/2019 |