Basic Information
| Provider Information | |||||||||
| NPI: | 1083044481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANTLE | ||||||||
| FirstName: | ANNE MARIE | ||||||||
| MiddleName: | VERONICA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163322121 | ||||||||
| FaxNumber: | 7163322122 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163322121 | ||||||||
| FaxNumber: | 7163322122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2013 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 338224 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.