Basic Information
| Provider Information | |||||||||
| NPI: | 1619983434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATINO | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 SHERIDAN DR | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168578666 | ||||||||
| FaxNumber: | 7168578944 | ||||||||
| Practice Location | |||||||||
| Address1: | 6333 MAIN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166301484 | ||||||||
| FaxNumber: | 7166301413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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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 | 363LA2200X | F303147-2 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | P00100487 | 01 | NY | RR MEDICARE | OTHER | 9512329 | 01 | NY | IHA | OTHER | 000560680002 | 01 | NY | HEALTH NOW | OTHER | 02344392 | 05 | NY | MEDICAID | 161000580 | 01 | NY | NOVA | OTHER |