Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F380378-1 | NY |
NPI | 1023112042 |
---|---|
Provider Name | Mrs. Beverly Ann Hornung |
First Address | Lancaster, NY 14086-9431 |
Second Address | Buffalo, NY 14212-1845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |