Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 30 305079 | NY |
NPI | 1013247154 |
---|---|
Provider Name | Mr. John R Hawk |
First Address | Buffalo, NY 14203-1070 |
Second Address | Buffalo, NY 14209-1120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 25/04/2016 |