Basic Information
| Provider Information | |||||||||
| NPI: | 1538126388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INNUS | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367979 | ||||||||
| FaxNumber: | 7166367993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367979 | ||||||||
| FaxNumber: | 7166367993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 006962 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 01978427 | 05 | NY | MEDICAID |