Basic Information
| Provider Information | |||||||||
| NPI: | 1598853806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAEFNER | ||||||||
| FirstName: | JOANNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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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 | 363L00000X | F333134-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 9513100 | 01 | NY | INDEPENDENT HEALTH | OTHER | 000560581005 | 01 | NY | BC/BS | OTHER | 00027632801 | 01 | NY | UNIVERA | OTHER | 02343011 | 05 | NY | MEDICAID |