Basic Information
| Provider Information | |||||||||
| NPI: | 1720397680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOMER | ||||||||
| FirstName: | KARIANN | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MECH | ||||||||
| OtherFirstName: | KARIANN | ||||||||
| OtherMiddleName: | MELISSA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RPA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1491 SHERIDAN DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163324476 | ||||||||
| FaxNumber: | 7164471286 | ||||||||
| Practice Location | |||||||||
| Address1: | 1491 SHERIDAN DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142171234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163324476 | ||||||||
| FaxNumber: | 7164471286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 363AM0700X | 014297 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.