1760732739 NPI number — MRS. DENISE M WALDRAFF RN, LPN

Table of content: MRS. DENISE M WALDRAFF RN, LPN (NPI 1760732739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760732739 NPI number — MRS. DENISE M WALDRAFF RN, LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALDRAFF
Provider First Name:
DENISE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, LPN
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:
1760732739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1431 HARLEM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14206-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-895-1126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 FRANKLIN ST
Provider Second Line Business Practice Location Address:
ALL METRO HEALTH CARE SUITE 205
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14202-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-856-2702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2012

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: 163W00000X , with the licence number:  514138-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 164W00000X , with the licence number: 233425-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 233425-1 . This is a "THE UNIVERSITY OF THE STATE OF NY ED. DEPT. OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 514138-1 . This is a "THE UNIVERSITY OF THE STATE OF NY ED. DEPT. OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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