Basic Information
Provider Information | |||||||||
NPI: | 1356765200 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STURZENBECKER | ||||||||
FirstName: | KIMBERLY | ||||||||
MiddleName: | JANE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | F.N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KOLASSA | ||||||||
OtherFirstName: | KIMBERLY | ||||||||
OtherMiddleName: | JANE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3085 HARLEM RD | ||||||||
Address2: | SUITE 350 | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142252591 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168445600 | ||||||||
FaxNumber: | 7168445750 | ||||||||
Practice Location | |||||||||
Address1: | 117 FOOTE AVE | ||||||||
Address2: | SUITE 100 | ||||||||
City: | JAMESTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 147016947 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7163389200 | ||||||||
FaxNumber: | 7163389250 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/13/2014 | ||||||||
LastUpdateDate: | 09/01/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 338527 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.