Basic Information
| Provider Information | |||||||||
| NPI: | 1326418799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECHEVERRIA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1526 WALDEN AVENUE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168956700 | ||||||||
| FaxNumber: | 7168950436 | ||||||||
| Practice Location | |||||||||
| Address1: | 1131 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142121501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168967350 | ||||||||
| FaxNumber: | 7168967717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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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 | 163W00000X | 610351 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.