1083672240 NPI number — WILLA ARNET NP

Table of content: MONET STAR BRYANT CPS (NPI 1508541525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083672240 NPI number — WILLA ARNET NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNET
Provider First Name:
WILLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083672240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7954 TRANSIT RD STE 134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-429-3344
Provider Business Mailing Address Fax Number:
949-655-8750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
461 JOHN JAMES AUDUBON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14228-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-429-3344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  F302128 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005603732 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026555801 . This is a "EXCELLUS UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02094902 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9512075 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com