Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F4202491 | NY |
NPI | 1033162540 |
---|---|
Provider Name | Marijane Cotroneo |
First Address | Tonawanda, NY 14150 |
Second Address | Tonawanda, NY 14150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000560138004 | BCBS (01) | |
0086173 | GHI (01) | |
156780CK | PREFERRED CARE (01) | |
9511748 | INDEPENDENT HEALTH (01) | |
F4206491 | NYS LICENSE (01) | |
MC0579500 | DEA (01) |