Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 300474 | NY |
NPI | 1003888058 |
---|---|
Provider Name | Donna Conway |
First Address | Buffalo, NY 14216-2611 |
Second Address | Buffalo, NY 14216-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P74144 | (02) |